Basic Information
| Provider Information | |||||||||
| NPI: | 1386848877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STOWELL | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 FAIRVIEW RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282103256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 645 AMALIA ST NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042953255 | ||||||||
| FaxNumber: | 7042953279 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2012-00637 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | NC6717A | 01 | NC | MEDICARE | OTHER | P01089959 | 01 | NC | MEDICARE RAILROAD | OTHER | Q0063V | 05 | SC | MEDICAID | 5920430 | 05 | NC | MEDICAID | 3476644 | 01 | UNITED HEALTHCARE | OTHER | 2890759 | 01 | CIGNA | OTHER | 2398810 | 01 | WELLPATH | OTHER | 009896871 | 01 | AETNA | OTHER | 1050276 | 01 | SC | WELLCARE OF SC | OTHER | 30120495 | 01 | SC | SELECT HEALTH | OTHER |