Individual
MARK A STEVENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 SOLOMIA DR, MILLS RIVER, NC 28759-0068
(603) 724-1954
Mailing address
1309 COFFEEN AVE STE 1200, SHERIDAN, WY 82801-5777
(603) 724-1954
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
2019-02734
NC
2084P0800X
Psychiatry Physician
Primary
2019-02734
NC
2084P0802X
Addiction Psychiatry Physician
2019-02734
NC
2084P0805X
Geriatric Psychiatry Physician
2019-02734
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1134145105
—
NC
05
—
30008716
—
NH
01
—
PENDING
MEDICARE
NC
Enumeration date
07/14/2006
Last updated
03/28/2023
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