Individual
MARY E. TREPHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1114 N MAIN ST, SUMMERVILLE, SC 29483-7326
(843) 212-8070
(843) 212-8071
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2644
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3767PA
—
SC
Enumeration date
04/29/2017
Last updated
06/03/2019
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