Basic Information
| Provider Information | |||||||||
| NPI: | 1013102607 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARC S. STEVENS, MD, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199341094 | ||||||||
| FaxNumber: | 9199349044 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199341094 | ||||||||
| FaxNumber: | 9199349044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | STEVENS | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9199341094 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2007-00574 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5907968 | 05 | NC | MEDICAID | 232122 | 01 | NC | MEDICARE ID | OTHER |