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General NPI Number Information
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NPI Number | 1376561613
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Entity Type | Individual
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Provider Name | STEPHEN STEPHENSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 1663 CAMPUS PARK DR SUITE D
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City | MONROE
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State | NC
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Zip | 28112-5581
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Country | US
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Telephone | 704-291-2488
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Fax | 704-283-0160
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Provider Business Mailing Address
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Address Line | 11301 CARMEL COMMONS BLVD STE 302
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City | CHARLOTTE
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State | NC
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Zip | 28226-5305
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Country | US
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Telephone | 704-372-7974
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Fax | 704-372-8201
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 200400415
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License Number State | NC
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