Healthcare Provider Details

I. General information

NPI: 1700838943
Provider Name (Legal Business Name): FITZGERALD EASLEY DRUMMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST CSB SUITE 812
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

1531 HARBORSUN DR
CHARLESTON SC
29412-8273
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2123
  • Fax: 843-792-0732
Mailing address:
  • Phone: 843-406-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number23951
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number23951
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number23951
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23951
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: