Healthcare Provider Details

I. General information

NPI: 1295724334
Provider Name (Legal Business Name): TRIDENT NEONATOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-4272
  • Fax: 843-797-4255
Mailing address:
  • Phone: 843-797-4272
  • Fax: 843-797-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT ENGLAND
Title or Position: VP
Credential:
Phone: 800-661-3365