Healthcare Provider Details

I. General information

NPI: 1639732464
Provider Name (Legal Business Name): ALEXANDER DUFFY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 RUTLEDGE AVE STE 1130
CHARLESTON SC
29425-4216
US

IV. Provider business mailing address

128 COLUMBUS ST APT 403
CHARLESTON SC
29403-4872
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-0791
  • Fax: 437-920-5468
Mailing address:
  • Phone: 609-668-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: