Provider Demographics
NPI:1760436893
Name:DIBERT, STEVEN WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WESLEY
Last Name:DIBERT
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 1:815 COX RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3453
Mailing Address - Country:US
Mailing Address - Phone:704-865-1700
Mailing Address - Fax:704-865-7948
Practice Address - Street 1:815 COX RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3453
Practice Address - Country:US
Practice Address - Phone:704-865-1700
Practice Address - Fax:704-865-7948
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC345952084N0400X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN34595Medicaid
NC28459OtherBLUE CROSS BLUE SHIELD
SCN34595Medicaid
NC22658OtherPARTNERS MEDICARE
NCF21528Medicare UPIN
NC2618384GMedicare ID - Type UnspecifiedINDV #
NC5902832Medicaid
SCN34595Medicaid