MEDICARE: DR. BETTINA HERBERT 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
1	208100000X	Physical Medicine & Rehabilitation Physician	37390	SC
2	208100000X	Physical Medicine & Rehabilitation Physician	MD427169	PA

General Provider Information

NPI Number	:	1699988279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETTINA HERBERT M.D.

Provider Business Mailing Address
First Line	:	852 LOWCOUNTRY BLVD
Second Line	:	STE 102, BOX 3
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-929-1634
Fax Number	:	843-929-1617

Provider Business Practice Location Address
First Line	:	852 LOWCOUNTRY BLVD
Second Line	:	STE 102, 3
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-929-1634
Fax Number	:	843-929-1617

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	05/27/2021

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