Provider Demographics
NPI:1396776803
Name:STEVENSON, ROGER CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:CHARLES
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5030
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0030
Mailing Address - Country:US
Mailing Address - Phone:302-992-0500
Mailing Address - Fax:302-993-2444
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 114
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-992-0500
Practice Address - Fax:302-993-2444
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000561207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DED01167Medicare UPIN