Provider Demographics
NPI:1710081294
Name:ROSTAN, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:ROSTAN
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3421
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8749
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-235-3398
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17600174400000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC73446OtherBLUE CROSS
NC8973446Medicaid
NCFH2000385OtherFIRSTCAROLIINACARE
NCP01310778OtherPALMETTO GBA RAILROAD MCR
SCQ17600OtherSC MEDICAID
NC210043Medicare ID - Type Unspecified
NCNCH258AMedicare PIN
NCC86220Medicare UPIN