Healthcare Provider Details

I. General information

NPI: 1013216282
Provider Name (Legal Business Name): STEPHEN TYLER ABBOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 CARTHAGE ST
SANFORD NC
27330-4162
US

IV. Provider business mailing address

260 LEIGH FARM RD APT 401
DURHAM NC
27707-8127
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-2350
  • Fax: 919-774-2132
Mailing address:
  • Phone: 401-480-4859
  • Fax: 919-774-2132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2016-01108
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2016-01108
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2016-01108
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: