Healthcare Provider Details

I. General information

NPI: 1184374662
Provider Name (Legal Business Name): DEAN JOSEPH WISEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2022
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2010
  • Fax:
Mailing address:
  • Phone: 843-724-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number96460
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: