Healthcare Provider Details

I. General information

NPI: 1174757850
Provider Name (Legal Business Name): STEFAN PLOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNIVERSITY PKWY
AIKEN SC
29801-6302
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-3321
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-5197
  • Fax: 803-641-5690
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number38080
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD482261
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: