Provider Demographics
NPI:1093875924
Name:MCLEAN J. STITH MD DERMATOLOGY DERMAPATHOLOGY
Entity Type:Organization
Organization Name:MCLEAN J. STITH MD DERMATOLOGY DERMAPATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MCLEAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:STITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-216-3376
Mailing Address - Street 1:852 LOWCOUNTRY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3067
Mailing Address - Country:US
Mailing Address - Phone:843-216-3376
Mailing Address - Fax:
Practice Address - Street 1:852 LOWCOUNTRY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3067
Practice Address - Country:US
Practice Address - Phone:843-216-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18640207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC186408Medicaid
SC=========OtherBCBS