Healthcare Provider Details

I. General information

NPI: 1952612608
Provider Name (Legal Business Name): SUSAN ERIN PRESNELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVE ROOM 202 MAIN HOSPITAL
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3575
  • Fax:
Mailing address:
  • Phone: 843-792-3575
  • Fax: 843-792-3537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number17486
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: