Healthcare Provider Details

I. General information

NPI: 1942199682
Provider Name (Legal Business Name): JACOB DOHMEIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-8972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMMD.94971LL
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: