Healthcare Provider Details

I. General information

NPI: 1821052556
Provider Name (Legal Business Name): DAVID S PETERSEIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST SUITE 690
CHARLESTON SC
29403-5736
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-720-8490
  • Fax: 843-727-3602
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number20706
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: