Healthcare Provider Details

I. General information

NPI: 1114592755
Provider Name (Legal Business Name): ALLISON BETH FREDERICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 ASHLEY AVENUE
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: 843-792-3072
  • Fax:
Mailing address:
  • Phone: 843-792-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL86081
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: