Provider Demographics
NPI:1225018971
Name:LEDER, STEVEN TODD (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:TODD
Last Name:LEDER
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 1:2317 DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-3137
Mailing Address - Country:US
Mailing Address - Phone:864-884-1143
Mailing Address - Fax:803-647-5726
Practice Address - Street 1:6539 GARNERS FERRY ROAD
Practice Address - Street 2:WJB DORN VAMC -DEPARTMENT OF ANESTHESIOLOGY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:803-647-5726
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD 23707207L00000X, 207LP2900X
SCMD23707207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC237078Medicaid
SCD705327588Medicare ID - Type Unspecified
SC237078Medicaid