Basic Information
| Provider Information | |||||||||
| NPI: | 1235216383 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL UNIVERSITY OF SOUTH CAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 96 JONATHAN LUCAS ST | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437923221 | ||||||||
| FaxNumber: | 8437928626 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 JONATHAN LUCAS ST | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437923221 | ||||||||
| FaxNumber: | 8437928626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAHADORI | ||||||||
| AuthorizedOfficialFirstName: | HAMID | ||||||||
| AuthorizedOfficialMiddleName: | REZA | ||||||||
| AuthorizedOfficialTitleorPosition: | RESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8437923221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | LL24898 | SC | Y | Hospitals | General Acute Care Hospital |
No ID Information.