Provider Demographics
NPI:1780605964
Name:VALDER, STEPHEN J (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:VALDER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14214 BALLANTYNE LAKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3372
Mailing Address - Country:US
Mailing Address - Phone:704-540-4460
Mailing Address - Fax:704-540-4502
Practice Address - Street 1:14214 BALLANTYNE LAKE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3372
Practice Address - Country:US
Practice Address - Phone:704-540-4460
Practice Address - Fax:704-540-4502
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NC95-00257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00257Medicaid
NC84612OtherBCBS
NC8984612Medicaid
SCN00257Medicaid