Healthcare Provider Details

I. General information

NPI: 1730329533
Provider Name (Legal Business Name): JOHN LITCHFIELD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2009
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414
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: 843-571-0311
Mailing address:
  • Phone: 843-571-0643
  • Fax: 843-571-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2187
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: