Provider Demographics
NPI:1841244910
Name:CARPEROS, STEPHANIE DEMETRA (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEMETRA
Last Name:CARPEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAYBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28515-9632
Mailing Address - Country:US
Mailing Address - Phone:252-745-3191
Mailing Address - Fax:252-745-7385
Practice Address - Street 1:606 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAYBORO
Practice Address - State:NC
Practice Address - Zip Code:28515-9632
Practice Address - Country:US
Practice Address - Phone:252-745-3191
Practice Address - Fax:252-745-7385
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32094207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21461OtherBCBS OF NC
NC8921461Medicaid
NCNCV787AMedicare PIN
NC8921461Medicaid
NCP00190018Medicare PIN
NC2030041AMedicare PIN