Provider Demographics
NPI:1891825964
Name:STEVENSON, MARVARETTA MIESHA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVARETTA
Middle Name:MIESHA
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3100 TOWER BLVD STE 600
Mailing Address - Street 2:BOX 3229
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2563
Mailing Address - Country:US
Mailing Address - Phone:919-419-5509
Mailing Address - Fax:919-493-3234
Practice Address - Street 1:1200 PINE RUN DR
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2180
Practice Address - Country:US
Practice Address - Phone:910-671-5730
Practice Address - Fax:910-671-5773
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122402207R00000X
NC2010-00887207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD83474Medicare UPIN