Provider Demographics
NPI:1831100064
Name:STEM, ERIC S (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:STEM
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 1:2880 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9171
Mailing Address - Country:US
Mailing Address - Phone:843-797-5050
Mailing Address - Fax:843-797-3633
Practice Address - Street 1:2880 TRICOM ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9171
Practice Address - Country:US
Practice Address - Phone:843-797-5050
Practice Address - Fax:843-797-3633
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24017207X00000X, 207XS0114X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT82158Medicaid
SC1326287434OtherMEDICAID DME NPI
SC57-0634057OtherTAX ID
SCT82158Medicaid
SC20076508OtherSELECT HEALTH DME
SC1225006760OtherGROUP NPI
SC20092905OtherSELECT HEALTH
SCP00732948OtherRAILROAD MEDICARE GROUP MEMBER PTAN
SCCD2877OtherRAILROAD MEDICARE GROUP PTAN
SCP00039467OtherRAILROAD MEDICARE
SC3204Medicare PIN
SCG074981701Medicare PIN
SCCD2877OtherRAILROAD MEDICARE GROUP PTAN
SCP00039467OtherRAILROAD MEDICARE