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Individual
STEPHEN ANDREW DERSCH
Active
Individual
STEPHEN ANDREW DERSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22678
SC
207QA0505X
Adult Medicine Physician
22678
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226785
—
SC
01
—
CN2547
RAILROAD MEDICARE- GROUP NUMBER
SC
01
—
GP4840
MEDICAID GROUP
SC
01
—
P00103192
RAILROAD MEDICARE- PROVIDER NUMBER
SC
Enumeration date
05/03/2006
Last updated
03/08/2021
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