Healthcare Provider Details

I. General information

NPI: 1235670746
Provider Name (Legal Business Name): STEPHEN MCQUEEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 LOCUST AVE
FAIRMONT WV
26554-1435
US

IV. Provider business mailing address

600 SUNCREST TOWN CENTRE DR STE 210
MORGANTOWN WV
26505-0589
US

V. Phone/Fax

Practice location:
  • Phone: 304-974-3297
  • Fax: 304-974-3299
Mailing address:
  • Phone: 304-598-4478
  • Fax: 304-599-0796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2044
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: