MEDICARE: MCLEAN J. STITH MD DERMATOLOGY DERMAPATHOLOGY

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
1	207ND0900X	Dermatopathology Physician	18640	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1093875924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCLEAN J. STITH MD DERMATOLOGY DERMAPATHOLOGY

Provider Business Mailing Address
First Line	:	852 LOWCOUNTRY BLVD STE 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-216-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	852 LOWCOUNTRY BLVD STE 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-216-3376
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MCLEAN J STITH
Credential	:	MD
Telephone Number	:	843-216-3376

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	08/22/2020

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