Provider Demographics
NPI:1508827098
Name:TAFEEN, STUART O (MD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:O
Last Name:TAFEEN
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:PO BOX 1689
Mailing Address - Street 2:
Mailing Address - City:ETOWAH
Mailing Address - State:NC
Mailing Address - Zip Code:28729-1689
Mailing Address - Country:US
Mailing Address - Phone:828-891-5524
Mailing Address - Fax:828-891-4069
Practice Address - Street 1:1900 ASHWOOD CT
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-3005
Practice Address - Country:US
Practice Address - Phone:336-282-1414
Practice Address - Fax:336-282-1515
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400421207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC81405OtherBCBS
NC8981405Medicaid
C80877Medicare UPIN
NC201761BMedicare PIN
NC406073322Medicare PIN