Healthcare Provider Details

I. General information

NPI: 1467486456
Provider Name (Legal Business Name): TRACY ANN BLUSEWICZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 PLANTATION PARK DR STE 401
BLUFFTON SC
29910-9006
US

IV. Provider business mailing address

29 PLANTATION PARK DR STE 401
BLUFFTON SC
29910-9006
US

V. Phone/Fax

Practice location:
  • Phone: 843-341-9700
  • Fax: 843-341-3282
Mailing address:
  • Phone: 843-341-9700
  • Fax: 843-341-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26583
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: