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General NPI Number Information
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NPI Number | 1235670746
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Entity Type | Individual
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Provider Name | STEPHEN MCQUEEN PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 1325 LOCUST AVE
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City | FAIRMONT
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State | WV
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Zip | 26554-1435
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Country | US
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Telephone | 304-974-3297
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Fax | 304-974-3299
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Provider Business Mailing Address
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Address Line | 600 SUNCREST TOWN CENTRE DR STE 210
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City | MORGANTOWN
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State | WV
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Zip | 26505-0589
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Country | US
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Telephone | 304-598-4478
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Fax | 304-599-0796
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2044
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License Number State | WV
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