Healthcare Provider Details

I. General information

NPI: 1023044245
Provider Name (Legal Business Name): TINA M BOTELHO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 LONG POINT RD # 100
MOUNT PLEASANT SC
29464-8000
US

IV. Provider business mailing address

550 LONG POINT RD # 100
MOUNT PLEASANT SC
29464-8000
US

V. Phone/Fax

Practice location:
  • Phone: 843-606-9199
  • Fax: 843-718-2858
Mailing address:
  • Phone: 843-606-9199
  • Fax: 843-718-2858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25344
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: