Provider Demographics
NPI:1508841859
Name:POLETTI, STEVEN CHARLES (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:CHARLES
Last Name:POLETTI
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:PO BOX 749340
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9340
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1625 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3698
Practice Address - Country:US
Practice Address - Phone:843-849-1551
Practice Address - Fax:843-884-0629
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15858207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC320058385OtherSTANDARD TAX ID
SCTL8418Medicaid
SCE36115Medicare ID - Type UnspecifiedMEDICARE OF SC
SCTL8418Medicaid
SCP00000838Medicare ID - Type UnspecifiedRAILROAD MEDICARE