Provider Demographics
NPI:1043393051
Name:ENRIGHT, GRETCHEN STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:STEPHANIE
Last Name:ENRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 GORZE RD
Mailing Address - Street 2:
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690-8386
Mailing Address - Country:US
Mailing Address - Phone:864-834-2105
Mailing Address - Fax:
Practice Address - Street 1:1 HAVENWOOD LN
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690-9447
Practice Address - Country:US
Practice Address - Phone:864-834-8013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163062084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF08834Medicare UPIN