MEDICARE: SEA ISLAND CANCER CENTER

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	207RH0003X	Hematology & Oncology Physician		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	:	1437118221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA ISLAND CANCER CENTER

Provider Business Mailing Address
First Line	:	1680B RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2008
Country	:	US
Telephone Number	:	843-521-9879
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680B RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-2008
Country	:	US
Telephone Number	:	843-521-9879
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. MAJD CHAHIN
Credential	:
Telephone Number	:	843-521-9879

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	08/17/2018

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1912942129 — RICHARD H FITZGERALD M.D.
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Directions to “SEA ISLAND CANCER CENTER ” Practice Location

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