Healthcare Provider Details

I. General information

NPI: 1669438206
Provider Name (Legal Business Name): DAVID J. FUNSCH, MD. PA.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POSTON RD PARKSHORE CENTRE, SUITE 145
CHARLESTON SC
29407-3424
US

IV. Provider business mailing address

1 POSTON RD PARKSHORE CENTRE, SUITE 145
CHARLESTON SC
29407-3424
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-4157
  • Fax: 843-763-8747
Mailing address:
  • Phone: 843-556-4157
  • Fax: 843-763-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15995
License Number StateSC

VIII. Authorized Official

Name: DR. DAVID JOHN FUNSCH
Title or Position: PRESIDENT
Credential: MD
Phone: 843-556-4157