Provider Demographics
NPI:1598134827
Name:NGIN, STEPHEN P
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:NGIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 NC 11 S
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590
Mailing Address - Country:US
Mailing Address - Phone:252-215-0467
Mailing Address - Fax:252-215-0984
Practice Address - Street 1:4211 NC 11 S
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590
Practice Address - Country:US
Practice Address - Phone:252-215-0467
Practice Address - Fax:252-215-0984
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25554183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0746053Medicaid
NC0282937018Medicare NSC