Healthcare Provider Details

I. General information

NPI: 1568446581
Provider Name (Legal Business Name): THOMAS CHARLES BELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NEW RIVER PARKWAY BLDG 6 SUITE 11
HARDEEVILLE SC
29927-4453
US

IV. Provider business mailing address

60 MAIN STREET SUITE D
HILTON HEAD ISLAND SC
29926-6603
US

V. Phone/Fax

Practice location:
  • Phone: 843-208-6442
  • Fax: 843-208-3401
Mailing address:
  • Phone: 843-689-6442
  • Fax: 843-689-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number26810
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number26810
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: