Healthcare Provider Details

I. General information

NPI: 1144280710
Provider Name (Legal Business Name): TE-LONG HWANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 MEDICAL PARK DRIVE SUITE 420, 8 MEDICAL PARK
COLUMBIA SC
29203-8003
US

IV. Provider business mailing address

3390 MEDICAL PARK DRIVE SUITE 420, 8 MEDICAL PARK
COLUMBIA SC
29203-8003
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-6050
  • Fax: 803-545-6051
Mailing address:
  • Phone: 803-545-6050
  • Fax: 803-545-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number13812
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: