Healthcare Provider Details

I. General information

NPI: 1700237187
Provider Name (Legal Business Name): HARLEY MOIT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 TWO ISLAND CT UNIT 203
MOUNT PLEASANT SC
29466-7406
US

IV. Provider business mailing address

1205 TWO ISLAND CT UNIT 203
MOUNT PLEASANT SC
29466-7406
US

V. Phone/Fax

Practice location:
  • Phone: 843-971-2860
  • Fax:
Mailing address:
  • Phone: 843-971-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125.069371
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number02006435A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2024-00961
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number93543
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: