Healthcare Provider Details

I. General information

NPI: 1376510255
Provider Name (Legal Business Name): MARTHA CAROLYN BRYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2260
  • Fax: 843-727-3631
Mailing address:
  • Phone: 843-554-9300
  • Fax: 843-566-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number10071
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number10071
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: