Healthcare Provider Details

I. General information

NPI: 1528128121
Provider Name (Legal Business Name): ELEANOR E. SAHN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SEVEN FARMS DR SUITE 105
DANIEL ISLAND SC
29492-8353
US

IV. Provider business mailing address

225 SEVEN FARMS DR SUITE 105
DANIEL ISLAND SC
29492-8353
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-4460
  • Fax: 843-971-0991
Mailing address:
  • Phone: 843-971-4460
  • Fax: 843-971-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11665
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier070016710
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerRR MEDICARE
# 2
IdentifierGP3471
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: DR. ELEANOR E SAHN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-971-4460