Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 213883 | SC |
NPI | 1568437143 |
---|---|
Provider Name | Stephen Irwin Merlin |
First Address | Columbia, SC 29201-3482 |
Second Address | Columbia, SC 29201-3482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 18/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400186 | (05) | SC |
582296052001 | BCBS PALMETTO HEALTH (01) |