Healthcare Provider Details

I. General information

NPI: 1730221037
Provider Name (Legal Business Name): KEVIN RAYMOND STEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 PROFESSIONAL PARK DR STE 150
WINSTON SALEM NC
27103
US

IV. Provider business mailing address

1450 PROFESSIONAL PARK DR
WINSTON SALEM NC
27103-1300
US

V. Phone/Fax

Practice location:
  • Phone: 336-724-2434
  • Fax: 336-724-6123
Mailing address:
  • Phone: 336-724-2434
  • Fax: 336-724-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2009-00182
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: