Provider Demographics
NPI:1750565784
Name:WORSHAM, STEPHEN FORD (MD MEDIACL DOCTOR)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:FORD
Last Name:WORSHAM
Suffix:
Gender:M
Credentials:MD MEDIACL DOCTOR
Other - Prefix:
Other - First Name:S
Other - Middle Name:F
Other - Last Name:WORSHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:109 BUFORD AVE
Mailing Address - Street 2:S F WORSHAM MD PA
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-224-1316
Mailing Address - Fax:864-224-5068
Practice Address - Street 1:109 BUFORD AVE
Practice Address - Street 2:S F WORSHAM MD PA
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-224-1316
Practice Address - Fax:864-224-5068
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC162157Medicaid
SC162157Medicaid
F29038Medicare UPIN