Provider Demographics
NPI:1407867351
Name:GEURKINK, DEANNE N (MD)
Entity type:Individual
Prefix:DR
First Name:DEANNE
Middle Name:N
Last Name:GEURKINK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11134 BROAD RIVER RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7616
Mailing Address - Country:US
Mailing Address - Phone:803-732-0920
Mailing Address - Fax:803-732-0920
Practice Address - Street 1:11134 BROAD RIVER RD
Practice Address - Street 2:SUITE D
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7616
Practice Address - Country:US
Practice Address - Phone:803-732-0920
Practice Address - Fax:803-732-0920
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC195002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC195005Medicaid
SCGP5337Medicaid