Healthcare Provider Details

I. General information

NPI: 1013980002
Provider Name (Legal Business Name): RONALD JAMES MCVICAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAVAGE RD
CHARLESTON SC
29407-4726
US

IV. Provider business mailing address

1849 SAVAGE RD
CHARLESTON SC
29407-4726
US

V. Phone/Fax

Practice location:
  • Phone: 843-766-7103
  • Fax: 843-576-2692
Mailing address:
  • Phone: 843-766-7103
  • Fax: 843-576-2692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number5101011938
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number1621
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: