Healthcare Provider Details

I. General information

NPI: 1164536215
Provider Name (Legal Business Name): SEAN J HISLOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 ASHLEY RIVER RD
CHARLESTON SC
29407-5384
US

IV. Provider business mailing address

1327 ASHLEY RIVER RD
CHARLESTON SC
29407-5384
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-4551
  • Fax: 843-577-8868
Mailing address:
  • Phone: 843-577-4551
  • Fax: 843-577-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number39157
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: