Healthcare Provider Details

I. General information

NPI: 1568437143
Provider Name (Legal Business Name): STEPHEN IRWIN MERLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 LADY ST STE B
COLUMBIA SC
29201-3482
US

IV. Provider business mailing address

1620 LADY ST STE B
COLUMBIA SC
29201-3482
US

V. Phone/Fax

Practice location:
  • Phone: 803-451-7600
  • Fax: 803-451-7604
Mailing address:
  • Phone: 803-451-7600
  • Fax: 803-451-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number213883
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: