Healthcare Provider Details

I. General information

NPI: 1730381252
Provider Name (Legal Business Name): SAMUEL KOFI OSEI OKOH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MEDICAL PARK DR SUITE 208
HARTSVILLE SC
29550-4777
US

IV. Provider business mailing address

701 MEDICAL PARK DR SUITE 208
HARTSVILLE SC
29550-4777
US

V. Phone/Fax

Practice location:
  • Phone: 843-339-3030
  • Fax: 843-383-0115
Mailing address:
  • Phone: 843-339-3030
  • Fax: 843-383-0115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number049961
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number049961
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207RH0005X
TaxonomyHypertension Specialist Physician
License Number049961
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number35390
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: