Provider Demographics
NPI:1437160256
Name:ELLIOTT, STEPHEN P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:P
Last Name:ELLIOTT
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 1:7510 N FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-4247
Mailing Address - Country:US
Mailing Address - Phone:843-572-1600
Mailing Address - Fax:843-572-1795
Practice Address - Street 1:7510 N FOREST DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4247
Practice Address - Country:US
Practice Address - Phone:843-572-1600
Practice Address - Fax:843-572-1795
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047161A207Q00000X
SC89433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01047161BOtherCSR
INDC3600OtherRAILROAD GROUP
INP00724943OtherRAILROAD INDIVIDUAL
INP00724943OtherRAILROAD INDIVIDUAL
IN01047161BOtherCSR
INH00627Medicare UPIN
IN198040Medicare PIN
IN220620G12Medicare PIN
IN220620G12Medicare PIN