Healthcare Provider Details

I. General information

NPI: 1275755019
Provider Name (Legal Business Name): SUSAN MARIE DEMARTINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN M. DABROWSKI M.D.

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 GROVE RD FL 1
GREENVILLE SC
29605-4210
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7899
  • Fax: 864-455-5474
Mailing address:
  • Phone: 864-522-8614
  • Fax: 315-464-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number267609
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number267609
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101243923
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number83775
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: