Provider Demographics
NPI:1477058626
Name:BAZICK, DEVIN (MD)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:BAZICK
Suffix:
Gender:F
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:GRAND STAND PEDIATRICS
Mailing Address - Street 2:8120 ROURK STREET
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4607
Mailing Address - Country:US
Mailing Address - Phone:843-449-1438
Mailing Address - Fax:
Practice Address - Street 1:GRAND STRAND PEDIATRICS
Practice Address - Street 2:5015 CAROLINA FOREST BLVD
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579
Practice Address - Country:US
Practice Address - Phone:843-945-1740
Practice Address - Fax:843-286-1349
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program