Healthcare Provider Details

I. General information

NPI: 1962452367
Provider Name (Legal Business Name): MICHAEL ANDREEVICH SAGATELIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

IV. Provider business mailing address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-0643
  • Fax: 843-377-0499
Mailing address:
  • Phone: 843-571-0643
  • Fax: 843-377-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101282315
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101282315
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18042
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: