Basic Information
| Provider Information | |||||||||
| NPI: | 1275840423 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL UNIVERSITY OF SOUTH CAROLINA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 COURTENAY DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437922300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 COURTENAY DR | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437922300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2010 | ||||||||
| LastUpdateDate: | 09/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | GREENBERG | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8437922211 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 4329 | SC | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.