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NPI Code Detail

MEDICARE: DR. PIAVE PITISCI LAKE M.D.

MEDICARE:  DR. PIAVE PITISCI LAKE  M.D.
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
12084P0800XPsychiatry Physician22627SC

General Provider Information

NPI Number : 1316075203
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PIAVE PITISCI LAKE M.D.
Provider Business Mailing Address
First Line : 115 FAIRCHILD ST STE 170
Second Line :
City : DANIEL ISLAND
State : SC
Zip : 29492-7602
Country : US
Telephone Number : 803-339-1563
Fax Number : 803-746-7902
Provider Business Practice Location Address
First Line : 115 FAIRCHILD ST STE 170
Second Line :
City : DANIEL ISLAND
State : SC
Zip : 29492-7602
Country : US
Telephone Number : 803-339-1563
Fax Number : 803-746-7902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 08/01/2022

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Directions to “ DR. PIAVE PITISCI LAKE M.D.” Practice Location

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