Healthcare Provider Details

I. General information

NPI: 1265753248
Provider Name (Legal Business Name): ALLEN E PENDARVIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 GARDNER RD STE 112
CHARLESTON SC
29407-5768
US

IV. Provider business mailing address

1064 GARDNER RD STE 112
CHARLESTON SC
29407-5768
US

V. Phone/Fax

Practice location:
  • Phone: 843-723-3441
  • Fax: 843-805-4040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number32696
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: