Basic Information
| Provider Information | |||||||||
| NPI: | 1841272465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12065 | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285612065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526335057 | ||||||||
| FaxNumber: | 2526330084 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 NEWMAN RD | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285625238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526335057 | ||||||||
| FaxNumber: | 2526330084 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085B0100X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085D0003X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging | 2085N0700X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0001X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0202X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0203X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0205X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085U0001X | 9300811 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0204X | 9300811 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 153000500 | 01 | NC | DOL | OTHER | 153405 | 01 | NC | VYTRA | OTHER | 897612A | 05 | NC | MEDICAID | C5187 | 01 | NC | MEDCOST | OTHER | 7612A | 01 | NC | BCBS OF NC | OTHER | 760158 | 01 | NC | MAMSI | OTHER |