Healthcare Provider Details

I. General information

NPI: 1144456708
Provider Name (Legal Business Name): STEPHEN REPLENSKI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 POSTAL WAY STE C
MYRTLE BEACH SC
29579-3537
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTN PATIENT ACCOUNTING
CONWAY SC
29526-9142
US

V. Phone/Fax

Practice location:
  • Phone: 843-903-4111
  • Fax: 843-903-4242
Mailing address:
  • Phone: 843-234-6946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT012995
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1625
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS13349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: