Provider Demographics
NPI:1720652472
Name:DERWITZ, KARLY ANNE (DO)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:ANNE
Last Name:DERWITZ
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER
Mailing Address - Street 2:14 MEDICAL PARK, STE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6155
Mailing Address - Fax:803-434-6979
Practice Address - Street 1:PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER
Practice Address - Street 2:14 MEDICAL PARK, STE 400
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-6979
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-08-02
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Provider Licenses
StateLicense IDTaxonomies
SCLL83483208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics