Provider Demographics
NPI:1548236680
Name:LODS, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:LODS
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 CODDLE MARKET DR NW
Practice Address - Street 2:STE 100
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2432
Practice Address - Country:US
Practice Address - Phone:980-302-9100
Practice Address - Fax:980-302-9110
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800611208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24246OtherPARTNERS MEDICARE CHOICE
NC1548236680Medicaid
NC5723622OtherAETNA
NC896409OtherMAMSI
NC79932OtherMEDCOST
NC891138JMedicaid
NC1138JOtherBCBS
NC561706219OtherPRACTICE TAX ID
NC17871OtherWELLPATH
NC5723622OtherAETNA