Healthcare Provider Details

I. General information

NPI: 1346602018
Provider Name (Legal Business Name): JEREMY LI AGOSTINHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3781 MCDOWELL LN STE 200
LITTLE RIVER SC
29566-8930
US

IV. Provider business mailing address

506 E CHEVES ST STE 202
FLORENCE SC
29506-2616
US

V. Phone/Fax

Practice location:
  • Phone: 843-366-6010
  • Fax: 843-366-2485
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number95983
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: