Provider Demographics
NPI:1720090384
Name:IULIANO, STEPHEN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:THOMAS
Last Name:IULIANO
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 MEDICAL PARK RD
Practice Address - Street 2:STE 111 - ADULT CARDIOLOGY
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8526
Practice Address - Country:US
Practice Address - Phone:704-801-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100382207R00000X, 207RC0000X, 207R00000X, 207RC0000X
SC26875207RC0000X
DCMD21984207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129MFMedicaid
P00271840OtherRAILROAD MEDICARE
NC129MFOtherBCBS
NC1720090384Medicaid
SCQ00383Medicaid
NC1720090384Medicaid
NC89129MFMedicaid
P00271840OtherRAILROAD MEDICARE