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NPI Code Detail

MEDICARE: STELA SUSAC-PAVIC M.D.

MEDICARE: STELA SUSAC-PAVIC M.D.
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
1207Q00000XFamily Medicine Physician01577NC
2207QA0505XAdult Medicine Physician35609SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101577OTHERNCMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
335609OTHERSCSOUTH CAROLINA MEDICAL LICENCE

General Provider Information

NPI Number : 1528288560
Entity Type Code : Individual
Provider Name (Legal Business Name) : STELA SUSAC-PAVIC M.D.
Provider Business Mailing Address
First Line : 3100 TRADITION CIR
Second Line :
City : MT PLEASANT
State : SC
Zip : 29466-7200
Country : US
Telephone Number : 843-501-2031
Fax Number : 843-884-6146
Provider Business Practice Location Address
First Line : 3100 TRADITION CIR
Second Line :
City : MT PLEASANT
State : SC
Zip : 29466-7200
Country : US
Telephone Number : 843-501-2031
Fax Number : 843-884-6146
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 08/04/2025

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