Provider Demographics
NPI:1194102384
Name:PECEVICH, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PECEVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32861
Mailing Address - Street 2:CMC/DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28232-2861
Mailing Address - Country:US
Mailing Address - Phone:704-355-3181
Mailing Address - Fax:704-355-7047
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:CMC/DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28232-2861
Practice Address - Country:US
Practice Address - Phone:704-355-3181
Practice Address - Fax:704-355-7047
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210229207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine