Healthcare Provider Details

I. General information

NPI: 1588451926
Provider Name (Legal Business Name): TATJANA MARIA MORTELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD STE 306
COLUMBIA SC
29203-6839
US

IV. Provider business mailing address

2 MEDICAL PARK RD STE 306
COLUMBIA SC
29203-6839
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8198
  • Fax:
Mailing address:
  • Phone: 803-434-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL97527
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: