Provider Demographics
NPI:1841205325
Name:LE, STACY COMFORT (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:COMFORT
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:C
Other - Last Name:LE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13220 ROSEDALE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-0361
Mailing Address - Country:US
Mailing Address - Phone:704-766-0320
Mailing Address - Fax:704-766-0407
Practice Address - Street 1:13220 ROSEDALE HILL AVE
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-0361
Practice Address - Country:US
Practice Address - Phone:704-766-0320
Practice Address - Fax:704-766-0407
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137HXMedicaid
NC2030023Medicare ID - Type Unspecified
NCE96133Medicare UPIN