Healthcare Provider Details

I. General information

NPI: 1669479986
Provider Name (Legal Business Name): EDWARD G BEHRENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/27/2006

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:
Mailing address:
  • Phone: 843-766-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20222
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: