Provider Demographics
NPI:1437112299
Name:PIETRUSZA, STEVEN JACOB (BSHS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JACOB
Last Name:PIETRUSZA
Suffix:
Gender:M
Credentials:BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 ROCKCREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-8915
Mailing Address - Country:US
Mailing Address - Phone:864-725-5020
Mailing Address - Fax:864-725-5615
Practice Address - Street 1:102 ROCKCREEK BLVD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-8915
Practice Address - Country:US
Practice Address - Phone:864-725-5020
Practice Address - Fax:864-725-5615
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant