Provider Demographics
NPI:1538172960
Name:DEMOSS, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:DEMOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501C MEMORIAL DR EXT
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651
Mailing Address - Country:US
Mailing Address - Phone:864-877-1220
Mailing Address - Fax:864-877-7731
Practice Address - Street 1:501C MEMORIAL DR EXT
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651
Practice Address - Country:US
Practice Address - Phone:864-877-1220
Practice Address - Fax:864-877-7731
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
562212236OtherCHAMPUS
SCGP2981Medicaid
SCGP2981Medicaid