Provider Demographics
NPI:1205824489
Name:PLOCH, NELSON RANDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:RANDOLPH
Last Name:PLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2890 TRICOM STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9171
Mailing Address - Country:US
Mailing Address - Phone:843-797-6600
Mailing Address - Fax:843-820-1440
Practice Address - Street 1:2890 TRICOM STREET
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-797-6600
Practice Address - Fax:843-820-1440
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17562208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7026OtherMEDICARE GROUP
SCGP4871Medicaid
SC340013328OtherRAILROAD MEDICARE
SCGP4871Medicaid