Provider Demographics
NPI:1356309967
Name:STEADMAN, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:STEADMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 FREEDOM BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6046
Mailing Address - Country:US
Mailing Address - Phone:843-664-9696
Mailing Address - Fax:843-669-1668
Practice Address - Street 1:1594 FREEDOM BLVD
Practice Address - Street 2:STE 202
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6046
Practice Address - Country:US
Practice Address - Phone:843-664-9696
Practice Address - Fax:843-669-1668
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC12322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080160596OtherRAILROAD MEDICARE
SC6341OtherMEDICARE GROUP NUMBER
SC123226Medicaid
SCD055636341Medicare PIN
SC080160596OtherRAILROAD MEDICARE