Individual
REGINA DERSTINE MONROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 PATEWOOD DR, SUITE A115, GREENVILLE, SC 29615-3593
(864) 454-5135
(864) 241-9200
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
32589
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
325892
—
SC
Enumeration date
05/16/2008
Last updated
09/14/2012
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