Healthcare Provider Details

I. General information

NPI: 1053848952
Provider Name (Legal Business Name): CAROLINA CARDIOVASCULAR CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 HAILE ST
CAMDEN SC
29020-3002
US

IV. Provider business mailing address

1330 HAILE ST
CAMDEN SC
29020-3002
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-6771
  • Fax: 803-424-1900
Mailing address:
  • Phone: 803-432-6771
  • Fax: 803-424-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateSC

VIII. Authorized Official

Name: DR. M TODD ALDERSON
Title or Position: OWNER
Credential: MD
Phone: 803-669-0914