Provider Demographics
NPI:1841511623
Name:VANEPPS, SUSAN FELLOWS (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:FELLOWS
Last Name:VANEPPS
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:PO BOX 7444
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-0012
Mailing Address - Country:US
Mailing Address - Phone:843-236-9669
Mailing Address - Fax:
Practice Address - Street 1:8590 SAN MARCELLO DR
Practice Address - Street 2:#101
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5281
Practice Address - Country:US
Practice Address - Phone:843-236-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11526207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology