Provider Demographics
NPI:1538254388
Name:LANDAU, STEVEN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:LANDAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:707 WILKINS ST
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4647
Mailing Address - Country:US
Mailing Address - Phone:919-209-9930
Mailing Address - Fax:919-209-9929
Practice Address - Street 1:707 WILKINS ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4647
Practice Address - Country:US
Practice Address - Phone:919-209-9930
Practice Address - Fax:919-209-9929
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7950708Medicaid
NCA61997Medicare UPIN
NC213252Medicare ID - Type Unspecified