Provider Demographics
NPI:1861487605
Name:STEVENS, MARC SHELDON (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:SHELDON
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:400 JOHNSON RIDGE MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2447
Mailing Address - Country:US
Mailing Address - Phone:336-526-4500
Mailing Address - Fax:336-526-8626
Practice Address - Street 1:400 JOHNSON RIDGE MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2447
Practice Address - Country:US
Practice Address - Phone:336-526-4500
Practice Address - Fax:336-526-8626
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00574207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC3927AMedicare PIN
NCI38248Medicare UPIN