Provider Demographics
NPI:1790745610
Name:CHABON, STEPHEN J (PA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:CHABON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 38008
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-8008
Mailing Address - Country:US
Mailing Address - Phone:336-545-5000
Mailing Address - Fax:336-545-5020
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-545-5000
Practice Address - Fax:336-545-5020
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC100682363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS43310Medicare UPIN
NC2744005BMedicare PIN