Provider Demographics
NPI:1164471751
Name:YOUSEFIAN, MEHRDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:YOUSEFIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 EDGELAND HWY
Mailing Address - Street 2:
Mailing Address - City:RICHBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29729-9478
Mailing Address - Country:US
Mailing Address - Phone:803-789-6111
Mailing Address - Fax:803-789-6118
Practice Address - Street 1:3248 EDGELAND HWY
Practice Address - Street 2:
Practice Address - City:RICHBURG
Practice Address - State:SC
Practice Address - Zip Code:29729-9478
Practice Address - Country:US
Practice Address - Phone:803-789-6111
Practice Address - Fax:803-789-6118
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC127730Medicaid
SCB914188625Medicare PIN
SC127730Medicaid