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NPI Code Detail

MEDICARE: THERESA ROSE ALDERSON MD

MEDICARE: THERESA ROSE ALDERSON 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
1208000000XPediatrics Physician27241SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
127241OTHERSCSC LIC

General Provider Information

NPI Number : 1568714053
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA ROSE ALDERSON MD
Provider Business Mailing Address
First Line : 645 S SEVENTH ST
Second Line : PO BOX 366
City : MC BEE
State : SC
Zip : 29101-7101
Country : US
Telephone Number : 843-335-8291
Fax Number : 843-335-8731
Provider Business Practice Location Address
First Line : 40 BALDWIN AVE
Second Line :
City : LUGOFF
State : SC
Zip : 29078-9406
Country : US
Telephone Number : 803-408-3262
Fax Number : 803-408-8895
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2012
Last Update Date : 07/29/2014

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