Healthcare Provider Details

I. General information

NPI: 1760436893
Provider Name (Legal Business Name): STEVEN WESLEY DIBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 COX RD
GASTONIA NC
28054-3453
US

IV. Provider business mailing address

815 COX RD
GASTONIA NC
28054-3453
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-1700
  • Fax: 704-865-7948
Mailing address:
  • Phone: 704-865-1700
  • Fax: 704-865-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34595
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number34595
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: