MEDICARE: EDUARDO CIFUENTES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	26779	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235161274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDUARDO CIFUENTES MD

Provider Business Mailing Address
First Line	:	2777 SPEISSEGGER DRIVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-8299
Country	:	US
Telephone Number	:	843-745-5153
Fax Number	:	843-766-8606

Provider Business Practice Location Address
First Line	:	2777 SPEISSEGGER DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29405-8229
Country	:	US
Telephone Number	:	843-745-5153
Fax Number	:	843-766-8606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/18/2013

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