Provider Demographics
NPI:1801820063
Name:NEUNER, JANICE MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:MARIE
Last Name:NEUNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 N LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2915
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:803-774-4627
Practice Address - Street 1:1278 N LAFAYETTE DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2964
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:803-774-4627
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC002106Medicaid
SCD05742Medicare UPIN