Provider Demographics
NPI:1831126200
Name:SEARSON, STACEY D II (MD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:SEARSON
Suffix:II
Gender:F
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 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-304-7000
Mailing Address - Fax:704-304-7008
Practice Address - Street 1:2001 VAIL AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1219
Practice Address - Country:US
Practice Address - Phone:704-304-7000
Practice Address - Fax:704-304-7008
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500250207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140XNOtherBCBS NC
NC1831126200Medicaid
NC5902724Medicaid
NC5917863Medicaid
SCN0025CMedicaid
NC5917863Medicaid
SCN0025CMedicaid