Healthcare Provider Details

I. General information

NPI: 1184824328
Provider Name (Legal Business Name): SUZANNE STELMACH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 COLLEGE ST
JACKSONVILLE NC
28540-5311
US

IV. Provider business mailing address

212 CREEDMOOR RD
JACKSONVILLE NC
28546-6027
US

V. Phone/Fax

Practice location:
  • Phone: 910-347-2154
  • Fax: 910-347-3165
Mailing address:
  • Phone: 910-938-3362
  • Fax: 910-347-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24101
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: