Provider Demographics
NPI:1376561613
Name:STEPHENSON, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:STEPHENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 CARMEL COMMONS BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5305
Mailing Address - Country:US
Mailing Address - Phone:704-372-7974
Mailing Address - Fax:704-372-8201
Practice Address - Street 1:1663 CAMPUS PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5581
Practice Address - Country:US
Practice Address - Phone:704-291-2488
Practice Address - Fax:704-283-0160
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200400415207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138C8Medicaid
NC2024990Medicare ID - Type Unspecified
NCI06022Medicare UPIN