Provider Demographics
NPI:1417925173
Name:MCELVEEN, FREDERICK JUDSON (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JUDSON
Last Name:MCELVEEN
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 1:2 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6808
Mailing Address - Country:US
Mailing Address - Phone:803-540-1000
Mailing Address - Fax:803-540-1075
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 506
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-540-1075
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5705207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA1426Medicaid
SC0301242OtherCAROLINA CARE PLAN
SC057057Medicaid
SCPA1426Medicaid
SC0462360001Medicare NSC
SCC607161786Medicare PIN
SC057057Medicaid