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NPI Code Detail

MEDICARE: STEPHANIE H TETTERTON PA

MEDICARE: STEPHANIE H TETTERTON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician860SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154339695
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE H TETTERTON PA
Provider Business Mailing Address
First Line : PO BOX 520
Second Line :
City : LUGOFF
State : SC
Zip : 29078-0520
Country : US
Telephone Number : 803-408-3277
Fax Number : 803-408-3282
Provider Business Practice Location Address
First Line : 15 EXCHANGE DR
Second Line :
City : LUGOFF
State : SC
Zip : 29078-9198
Country : US
Telephone Number : 803-408-3277
Fax Number : 803-408-3282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 09/22/2011

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Directions to “ STEPHANIE H TETTERTON PA” Practice Location

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