Healthcare Provider Details

I. General information

NPI: 1861596009
Provider Name (Legal Business Name): CHRISTINE T CHIAVIELLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1096 RIBAUT RD
BEAUFORT SC
29902
US

IV. Provider business mailing address

1096 RIBAUT RD
BEAUFORT SC
29902
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-5550
  • Fax: 843-524-6798
Mailing address:
  • Phone: 843-524-5550
  • Fax: 843-524-6798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number17636
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: