Provider Demographics
NPI:1538139431
Name:BURCHETT, STEPHANIE (MD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:
Last Name:BURCHETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 CHURCH STREET N
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4375
Mailing Address - Country:US
Mailing Address - Phone:704-403-2276
Mailing Address - Fax:704-795-2181
Practice Address - Street 1:845 CHURCH STREET N
Practice Address - Street 2:SUITE 310
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4375
Practice Address - Country:US
Practice Address - Phone:704-403-2276
Practice Address - Fax:704-795-2181
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001080207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC127F5OtherBCBS ID
NC7782150OtherAETNA
NC899041OtherMAMSI
NC208086951OtherGROUP TAX ID
NC232008OtherMEDICARE GROUP PTAN
NC39562OtherPARTNERS MEDICARE CHOICE
NC0443773OtherUNITED HEALTHCARE ID
NC110217324OtherRAILROAD MEDICARE ID
NC23315OtherMEDCOST
NC89127F5Medicaid
NC102574OtherWELLPATH ID
NC7782150OtherAETNA
NC2280994AMedicare ID - Type UnspecifiedMEDICARE ID