Healthcare Provider Details

I. General information

NPI: 1972693257
Provider Name (Legal Business Name): VINCENT J DEGENHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ROBERTS STREET KERSHAW HEALTH
CAMDEN SC
29020
US

IV. Provider business mailing address

PO BOX 2344
COLUMBIA SC
29202-2344
US

V. Phone/Fax

Practice location:
  • Phone: 803-713-2619
  • Fax:
Mailing address:
  • Phone: 803-254-2394
  • Fax: 803-254-7125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number8917
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number8917
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number8917
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: