Healthcare Provider Details

I. General information

NPI: 1427494939
Provider Name (Legal Business Name): MUSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CANNON ST SUITE 503
CHARLESTON SC
29425-7901
US

IV. Provider business mailing address

165 CANNON ST # 503
CHARLESTON SC
29425-7901
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberA134887
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA134887
License Number StateCA

VIII. Authorized Official

Name: IGOR GALAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 805-928-7361