Individual
DR. JOSEPH W DEROSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 ARBORLAND WAY, GREENVILLE, SC 29615-2201
(864) 297-6010
(864) 458-7673
Mailing address
12 ARBORLAND WAY, GREENVILLE, SC 29615-2201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21247
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SCE5645193
MEDICARE PIN
SC
05
—
T54394
—
SC
Enumeration date
07/11/2006
Last updated
12/21/2020
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