Provider Demographics
NPI:1508834342
Name:WOERTH, STANLEY D (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:D
Last Name:WOERTH
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 1:9263 MEDICAL PLAZA DR
Mailing Address - Street 2:STE E
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7112
Mailing Address - Country:US
Mailing Address - Phone:843-572-1228
Mailing Address - Fax:877-561-7564
Practice Address - Street 1:9263 MEDICAL PLAZA DR
Practice Address - Street 2:STE E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7112
Practice Address - Country:US
Practice Address - Phone:843-572-1228
Practice Address - Fax:877-561-7564
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7866207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC078668Medicaid
SCB926413605Medicare ID - Type Unspecified
SC078668Medicaid