Provider Demographics
NPI:1457388316
Name:HEAVNER, STEVEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:B
Last Name:HEAVNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:
Practice Address - Street 1:13532 STEELECROFT PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7545
Practice Address - Country:US
Practice Address - Phone:704-295-3475
Practice Address - Fax:704-295-3476
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD40839207Y00000X
NC200700368207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147TUOtherBCBSNC
SC000000292751OtherUNISON HEALTH PLAN OF SC
NC5907396Medicaid
SC20096068OtherSELECT HEALTH OF SC
NC4997345OtherCIGNA HEALTHCARE
SCN68007Medicaid
SC773189OtherWELLCARE
P00751041OtherRAILROAD MEDICARE
NC7494811OtherAETNA
NC7494811OtherAETNA
NC5907396Medicaid