Provider Demographics
NPI:1538173794
Name:DENENBERG, MICHAEL B (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:B
Last Name:DENENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:370 SOUTH HERLONG AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3155
Mailing Address - Country:US
Mailing Address - Phone:803-980-5864
Mailing Address - Fax:803-980-5865
Practice Address - Street 1:370 SOUTH HERLONG AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3155
Practice Address - Country:US
Practice Address - Phone:803-980-5864
Practice Address - Fax:803-980-5817
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD21599207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2964Medicaid
SCGP2964Medicaid
SCG308090281Medicare ID - Type UnspecifiedMEDICARE #