Provider Demographics
NPI:1538160049
Name:STEM, THEODORE B JR (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:B
Last Name:STEM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:562 SHEARER ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2746
Practice Address - Country:US
Practice Address - Phone:724-836-8303
Practice Address - Fax:724-836-8311
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-09-08
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Provider Licenses
StateLicense IDTaxonomies
NC2016-01133207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010404120001Medicaid
PAC34499Medicare UPIN
PA0010404120001Medicaid