Healthcare Provider Details

I. General information

NPI: 1043573009
Provider Name (Legal Business Name): IRL BRIAN GREENWELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2012
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 HENRY TECKLENBURG DR
CHARLESTON SC
29414-7710
US

IV. Provider business mailing address

PO BOX 751874
CHARLOTTE NC
28275-1874
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-6957
  • Fax: 843-577-6523
Mailing address:
  • Phone: 843-402-5200
  • Fax: 843-402-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number52275
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: