Provider Demographics
NPI:1750381604
Name:BUSCHOR, TERESA L (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:L
Last Name:BUSCHOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 W WESMARK BLVD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1977
Mailing Address - Country:US
Mailing Address - Phone:803-607-9430
Mailing Address - Fax:803-607-9431
Practice Address - Street 1:380 W WESMARK BLVD
Practice Address - Street 2:BUILDING B
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1977
Practice Address - Country:US
Practice Address - Phone:803-607-9430
Practice Address - Fax:803-607-9431
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21022208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC210220Medicaid
SC210220Medicaid
SCH493277203Medicare ID - Type Unspecified