Provider Demographics
NPI:1457408338
Name:STEVENSON, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:STEVENSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 BURNET AVE., ML 2016
Mailing Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-4726
Mailing Address - Fax:513-636-2808
Practice Address - Street 1:3333 BURNET AVE., ML 2016
Practice Address - Street 2:CINCINNATI CHILDREN'S HOSPITAL
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4726
Practice Address - Fax:513-636-2808
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.091452207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3730541000OtherPASSPORT ADVANTAGE - NNIKY
KY106186OtherSIHO - NNIKY
IN200963990Medicaid
KY9877110OtherCIGNA - NNIKY
KY000026447VOtherHUMANA - NNIKY
KY000000642009OtherANTHEM - NNIKY
KY7100077020Medicaid
KY50025169OtherPASSPORT - NNIKY
KY3730541000OtherPASSPORT ADVANTAGE - NNIKY