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STEPHEN ANDREW DERSCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
805 PAMPLICO HWY STE B135, FLORENCE, SC 29505-6047
(843) 674-6414
(843) 674-2642
Mailing address
PO BOX 603898, CHARLOTTE, NC 28260-3898
(843) 792-6200

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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