Healthcare Provider Details

I. General information

NPI: 1770687063
Provider Name (Legal Business Name): DENNIS MICHAEL HULL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9295 MEDICAL PLAZA DR SUITE B
CHARLESTON SC
29406-9137
US

IV. Provider business mailing address

9295 MEDICAL PLAZA DR SUITE B
CHARLESTON SC
29406-9137
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-3960
  • Fax: 843-553-4216
Mailing address:
  • Phone: 843-797-3960
  • Fax: 843-553-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7845
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: