Healthcare Provider Details

I. General information

NPI: 1124169479
Provider Name (Legal Business Name): MARWAN KAMIL ELYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHEVES ST SUITE 202
FLORENCE SC
29506-2615
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7863
  • Fax: 843-777-7873
Mailing address:
  • Phone: 843-777-7863
  • Fax: 843-777-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number30478
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number30478
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number30478
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: