Provider Demographics
NPI:1780773838
Name:FORD, STEPHEN MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MITCHELL
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4106 TROTTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-5529
Mailing Address - Country:US
Mailing Address - Phone:919-489-7346
Mailing Address - Fax:
Practice Address - Street 1:DOROTHEA DIX HOSPITAL
Practice Address - Street 2:820 S. BOYLAN AVE.
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603
Practice Address - Country:US
Practice Address - Phone:919-733-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC295702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD32392Medicare UPIN