Provider Demographics
NPI:1780865774
Name:THOMAS N STEPHENSON, M.D., P.A.
Entity Type:Organization
Organization Name:THOMAS N STEPHENSON, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:M,D
Authorized Official - Phone:919-929-1101
Mailing Address - Street 1:194 FINLEY GOLF COURSE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-4400
Mailing Address - Country:US
Mailing Address - Phone:919-929-1101
Mailing Address - Fax:919-929-1148
Practice Address - Street 1:194 FINLEY GOLF COURSE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-4400
Practice Address - Country:US
Practice Address - Phone:919-929-1101
Practice Address - Fax:919-929-1148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19829261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201625Medicare PIN