Healthcare Provider Details

I. General information

NPI: 1689945651
Provider Name (Legal Business Name): MARWAN AL ASWAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 CAROLINA EXCHANGE DRIVE
MYRTLE BEACH SC
29579-4220
US

IV. Provider business mailing address

PO BOX 547
LITTLE RIVER SC
29566-0547
US

V. Phone/Fax

Practice location:
  • Phone: 843-663-8000
  • Fax: 843-663-8123
Mailing address:
  • Phone: 843-663-8000
  • Fax: 843-663-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37257
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: