Healthcare Provider Details

I. General information

NPI: 1396776803
Provider Name (Legal Business Name): ROGER CHARLES STEVENSON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/05/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD SUITE 114
WILMINGTON DE
19808-5400
US

IV. Provider business mailing address

PO BOX 5030
WILMINGTON DE
19808-0030
US

V. Phone/Fax

Practice location:
  • Phone: 302-992-0500
  • Fax: 302-993-2444
Mailing address:
  • Phone: 302-992-0500
  • Fax: 302-993-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC10000561
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: