Healthcare Provider Details

I. General information

NPI: 1285684548
Provider Name (Legal Business Name): OSEMWEGIE EMMANUEL EMOVON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR SUITE 205E
CHARLESTON SC
29414-5741
US

IV. Provider business mailing address

PO BOX 81113 ASHLEY RIVER STATION
CHARLESTON SC
29416-1113
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-0499
  • Fax: 843-388-6292
Mailing address:
  • Phone: 843-573-0499
  • Fax: 843-388-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number22793S
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: