Provider Demographics
NPI:1346387388
Name:OSAGUONA, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:OSAGUONA
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 1:2601 LAUREL ST STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2034
Mailing Address - Country:US
Mailing Address - Phone:843-233-3700
Mailing Address - Fax:877-460-4542
Practice Address - Street 1:2601 LAUREL ST STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2034
Practice Address - Country:US
Practice Address - Phone:843-233-3700
Practice Address - Fax:877-460-4542
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44735207R00000X
NC2010-01400207RN0300X
SC29582207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC295825Medicaid
NC5916035Medicaid
SCPO1239847OtherRAILROAD MEDICARE
SCAA27579068Medicare PIN
SCAA27575019Medicare PIN