Basic Information
| Provider Information | |||||||||
| NPI: | 1043953870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERSON | ||||||||
| FirstName: | STECKER | ||||||||
| MiddleName: | TAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 EXECUTIVE DR STE H | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245414155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347911345 | ||||||||
| FaxNumber: | 4347736811 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 EXECUTIVE DR STE H | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245414155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4347911345 | ||||||||
| FaxNumber: | 4347736811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2022 | ||||||||
| LastUpdateDate: | 06/09/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/09/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0116036312 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.