Provider Demographics
NPI:1508805847
Name:CHRISTIAN, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:CHRISTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:555 E CHEVES ST
Mailing Address - Street 2:DEPT OF RADIOLOGY/MRMC
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2617
Mailing Address - Country:US
Mailing Address - Phone:843-777-2879
Mailing Address - Fax:
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC277212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC277211Medicaid
NC5903818OtherMEDICAID OF NC
SC154758900OtherUS DEPT OF LABOR
SC154758900OtherFEDERAL BLACK LUNG
SCE4437OtherMEDCOST
SC570525838OtherSTANDARD TAX ID
SC154758900OtherFEDERAL BLACK LUNG
NC5903818OtherMEDICAID OF NC
SCE4437OtherMEDCOST