Provider Demographics
NPI:1801877980
Name:SELTZER, STEPHEN CHARLES (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHARLES
Last Name:SELTZER
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 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-982-9144
Mailing Address - Fax:704-512-4838
Practice Address - Street 1:105 YADKIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3449
Practice Address - Country:US
Practice Address - Phone:704-982-9144
Practice Address - Fax:704-512-4838
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22828207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1801877980Medicaid
NC7975199Medicaid
080096127OtherRAIL ROAD MEDICARE
210301AMedicare PIN
NC1801877980Medicaid
080096127OtherRAIL ROAD MEDICARE