Individual
STEPHEN BRADLEY TATTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-4081
(336) 716-3065
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-0238
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
9701168
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1069G
BCBS
—
01
—
140007850
RR MEDICARE
—
01
—
21294
PARTNERS
—
05
—
3002835000
—
WV
01
—
5171443
AETNA
—
05
—
6105424
—
VA
01
—
74319
MEDCOST
—
05
—
891069G
—
NC
05
—
Q01168
—
SC
Enumeration date
01/13/2006
Last updated
06/14/2022
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