Healthcare Provider Details

I. General information

NPI: 1841425832
Provider Name (Legal Business Name): O'NEILL PLASTIC SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SEVEN FARMS DR STE 210
DANIEL ISLAND SC
29492-8500
US

IV. Provider business mailing address

245 SEVEN FARMS DR STE 210
DANIEL ISLAND SC
29492-8500
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-2130
  • Fax:
Mailing address:
  • Phone: 843-881-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number008205239
License Number StateSC

VIII. Authorized Official

Name: DR. PATRICK JOSEPH O'NEILL
Title or Position: OWNER
Credential: M.D.
Phone: 843-881-2130