1801877980 NPI number — STEPHEN CHARLES SELTZER MD

Table of content: STEPHEN CHARLES SELTZER MD (NPI 1801877980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801877980 NPI number — STEPHEN CHARLES SELTZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SELTZER
Provider First Name:
STEPHEN
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801877980
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 601888
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28260-1888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-982-9144
Provider Business Mailing Address Fax Number:
704-512-4838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 YADKIN ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ALBEMARLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28001-3449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-982-9144
Provider Business Practice Location Address Fax Number:
704-512-4838
Provider Enumeration Date:
11/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  22828 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1801877980 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7975199 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080096127 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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