Healthcare Provider Details

I. General information

NPI: 1275103632
Provider Name (Legal Business Name): ARIEL HANOCH KERPEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

99 WESTEDGE ST APT 231
CHARLESTON SC
29403-4981
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0337
  • Fax:
Mailing address:
  • Phone: 843-609-0593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number12345
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number86457
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: