Healthcare Provider Details

I. General information

NPI: 1376597062
Provider Name (Legal Business Name): STUART L TESSLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MARKFIELD DR #3
CHARLESTON SC
29407-7907
US

IV. Provider business mailing address

60 MARKFIELD DR STE 3
CHARLESTON SC
29407-7907
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-0602
  • Fax: 843-571-0605
Mailing address:
  • Phone: 843-571-0602
  • Fax: 843-571-0605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number139
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: