Provider Demographics
NPI:1598740201
Name:STROCKO, STEVEN MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MICHAEL
Last Name:STROCKO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6607
Mailing Address - Country:US
Mailing Address - Phone:843-682-3955
Mailing Address - Fax:843-682-3956
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-6607
Practice Address - Country:US
Practice Address - Phone:843-682-3955
Practice Address - Fax:843-682-3956
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1933OtherSTATE LICENSE
SCSC14119192Medicare PIN