Provider Demographics
NPI:1467595496
Name:STAMPER, ELMER JR (PA)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:
Last Name:STAMPER
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5727 PROSPERITY CROSSING DR
Practice Address - Street 2:STE 1100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2206
Practice Address - Country:US
Practice Address - Phone:704-863-9930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPA2072363A00000X
NC100823363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0818PAMedicaid
NC1467595496Medicaid
NCNCG842AMedicare PIN
NCNCG842DMedicare PIN
NCNCG842EMedicare PIN
NCNCG842FMedicare PIN
NCNCG842CMedicare PIN
SC0818PAMedicaid
NCNCG842BMedicare PIN