Provider Demographics
NPI:1861468779
Name:CHIAVETTA, STEPHEN VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:VICTOR
Last Name:CHIAVETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:4420 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7505
Practice Address - Country:US
Practice Address - Phone:919-784-3040
Practice Address - Fax:919-784-3362
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20650207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8922452Medicaid
NC22452OtherBCBS
NC22452OtherBCBS
C83209Medicare UPIN