Healthcare Provider Details

I. General information

NPI: 1609825561
Provider Name (Legal Business Name): PALMETTO PULMONARY PHYSICIANS OF CHARLESTON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WAPPOO CREEK DR SUITE 3-A
CHARLESTON SC
29412-2134
US

IV. Provider business mailing address

105 WAPPOO CREEK DR SUITE 3-A
CHARLESTON SC
29412-2134
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-1025
  • Fax: 843-795-1081
Mailing address:
  • Phone: 843-795-1025
  • Fax: 843-795-1081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10847
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number10847
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number10847
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number10847
License Number StateSC

VIII. Authorized Official

Name: DR. CARY ERWIN FECHTER
Title or Position: OWNER
Credential: M.D
Phone: 843-795-1025