Provider Demographics
NPI:1760440812
Name:QUEEN, STEVEN WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:WESLEY
Last Name:QUEEN
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 1045
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-1045
Mailing Address - Country:US
Mailing Address - Phone:828-586-8971
Mailing Address - Fax:
Practice Address - Street 1:98 DOCTORS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-4501
Practice Address - Country:US
Practice Address - Phone:828-586-8971
Practice Address - Fax:828-586-4083
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8969577Medicaid
NC8969577Medicaid
NCF06233Medicare UPIN