Provider Demographics
NPI:1568437143
Name:MERLIN, STEPHEN IRWIN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:IRWIN
Last Name:MERLIN
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 1:1620 LADY ST STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3482
Mailing Address - Country:US
Mailing Address - Phone:803-451-7600
Mailing Address - Fax:803-451-7604
Practice Address - Street 1:1620 LADY ST STE B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3482
Practice Address - Country:US
Practice Address - Phone:803-451-7600
Practice Address - Fax:803-451-7604
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213883207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
582296052001OtherBCBS PALMETTO HEALTH
SC400186Medicaid
SC400186Medicaid