Provider Demographics
NPI:1780560201
Name:TEPFENHART, MADISON
Entity type:Individual
Prefix:DR
First Name:MADISON
Middle Name:
Last Name:TEPFENHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 HOLDEN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5824
Mailing Address - Country:US
Mailing Address - Phone:803-412-6201
Mailing Address - Fax:
Practice Address - Street 1:975 SAVANNAH HWY STE 105
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7868
Practice Address - Country:US
Practice Address - Phone:843-212-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily