Provider Demographics
NPI:1730529470
Name:ELDRIDGE, STEPHANIE (DPM)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 TATE BLVD SE STE 203
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1385
Mailing Address - Country:US
Mailing Address - Phone:828-304-0400
Mailing Address - Fax:828-304-0142
Practice Address - Street 1:1501 TATE BLVD SE STE 203
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1385
Practice Address - Country:US
Practice Address - Phone:828-304-0400
Practice Address - Fax:828-304-0142
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006464213E00000X
NC628213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCT007AMedicare PIN