Healthcare Provider Details

I. General information

NPI: 1699743344
Provider Name (Legal Business Name): JOSEPH F VALICENTI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DRIVE DEPARTMENT OF PATHOLOGY
CHARLESTON SC
29418-9195
US

IV. Provider business mailing address

PO BOX 60070
CHARLESTON SC
29419-0070
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-4179
  • Fax: 843-797-4296
Mailing address:
  • Phone: 843-797-4179
  • Fax: 843-792-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number6755
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: