Provider Demographics
NPI:1710965520
Name:BURKHOLZ, STEVEN ROY (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROY
Last Name:BURKHOLZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:103 OLD PROVINCE WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4479
Mailing Address - Country:US
Mailing Address - Phone:864-322-4082
Mailing Address - Fax:864-322-4083
Practice Address - Street 1:10306 EATON PL
Practice Address - Street 2:SUITE 180
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2201
Practice Address - Country:US
Practice Address - Phone:800-910-3769
Practice Address - Fax:703-667-3495
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0570207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE76782Medicare UPIN
SCT00844Medicare ID - Type UnspecifiedMEDICAID ID#