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General NPI Number Information
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NPI Number | 1134145105
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Entity Type | Individual
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Provider Name | MARK A STEVENS MD
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Gender | Male
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 19 SOLOMIA DR
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City | MILLS RIVER
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State | NC
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Zip | 28759-0068
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Country | US
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Telephone | 603-724-1954
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Fax |
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Provider Business Mailing Address
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Address Line | 1309 COFFEEN AVE STE 1200
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 603-724-1954
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number | 2019-02734
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 2019-02734
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 2019-02734
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 2019-02734
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License Number State | NC
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