Individual
DR. VINCENT J DEGENHART
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1315 ROBERTS STREET, KERSHAW HEALTH, CAMDEN, SC 29020
(803) 713-2619
Mailing address
PO BOX 2344, COLUMBIA, SC 29202-2344
(803) 254-2394
(803) 254-7125
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
8917
SC
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
8917
SC
207LP2900X
Pain Medicine (Anesthesiology) Physician
8917
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050028863
RR MEDICARE
SC
01
—
089175
SELECT HEALTH
SC
05
—
089175
—
SC
01
—
2000078
CCP
SC
01
—
4129441
AETNA
SC
01
—
77789
MEDCOST
SC
Enumeration date
10/15/2006
Last updated
06/05/2019
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