Healthcare Provider Details

I. General information

NPI: 1861468779
Provider Name (Legal Business Name): STEPHEN VICTOR CHIAVETTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

PO BOX 100559
FLORENCE SC
29501-0559
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-3040
  • Fax: 919-784-3362
Mailing address:
  • Phone: 843-664-4300
  • Fax: 843-664-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number20650
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20650
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: