Healthcare Provider Details

I. General information

NPI: 1700242260
Provider Name (Legal Business Name): ROBERT DURANT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 BOWMAN RD STE 104
MOUNT PLEASANT SC
29464-3235
US

IV. Provider business mailing address

913 BOWMAN RD STE 104
MOUNT PLEASANT SC
29464-3235
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-2535
  • Fax:
Mailing address:
  • Phone: 843-216-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD32844
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1932454238
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerINDIVIDUAL NPI; NO MEDICARE NUMBER
# 2
Identifier1114035086
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerINDIVIDUAL NPI; NO MEDICARE NUMBER
# 3
Identifier1932399292
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerINDIVIDUAL NPI; NO MEDICARE NUMBER

VIII. Authorized Official

Name: BETH WEIKEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-216-2535