Provider Demographics
NPI:1396714374
Name:POGUE, ZOE KLECKNER (MD)
Entity type:Individual
Prefix:MS
First Name:ZOE
Middle Name:KLECKNER
Last Name:POGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8906 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6366
Mailing Address - Country:US
Mailing Address - Phone:803-254-3676
Mailing Address - Fax:803-254-3678
Practice Address - Street 1:99 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5359
Practice Address - Country:US
Practice Address - Phone:843-572-3300
Practice Address - Fax:843-797-3331
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19473208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC194738Medicaid