Provider Demographics
NPI:1912965583
Name:STAMP, IAN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:PATRICK
Last Name:STAMP
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 1149
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28151-1149
Mailing Address - Country:US
Mailing Address - Phone:704-487-4321
Mailing Address - Fax:704-487-9561
Practice Address - Street 1:1413 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3406
Practice Address - Country:US
Practice Address - Phone:704-487-4321
Practice Address - Fax:704-487-9561
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC212561OtherWELLPATH
NC4239013OtherCIGNA
NC1171EOtherBLUECROSSBLUESHIELD
NC830385722OtherHUMANA,AETNA,CONNECTICUT
NC891171EMedicaid
NC891171EMedicaid
NC212561OtherWELLPATH