Healthcare Provider Details

I. General information

NPI: 1578784609
Provider Name (Legal Business Name): CBD MEDICAL ENTERPRISES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 OLD GEORGETOWN HWY SUITE B
MT PLEASANT SC
29464
US

IV. Provider business mailing address

702 WHISPERING MARSH DR
CHARLESTON SC
29412
US

V. Phone/Fax

Practice location:
  • Phone: 843-216-9870
  • Fax: 843-216-9872
Mailing address:
  • Phone: 843-762-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13634
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number13634
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13634
License Number StateSC

VIII. Authorized Official

Name: DR. THOMAS A DUC JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 843-762-3235