Provider Demographics
NPI:1801848650
Name:TRIMBLE, STEWART ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEWART
Middle Name:ALAN
Last Name:TRIMBLE
Suffix:
Gender:
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 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:888-472-0043
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:501 CARNES CROSSING BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-0407
Practice Address - Country:US
Practice Address - Phone:843-212-8080
Practice Address - Fax:843-203-2299
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01587207R00000X
SC93068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750560504OtherGROUP PROVIDER NPI
NC03-0455058OtherFEDERAL TAX ID#
NCI70268Medicare UPIN
NC1750560504OtherGROUP PROVIDER NPI
NCNC0499BMedicare PIN