Healthcare Provider Details

I. General information

NPI: 1558774497
Provider Name (Legal Business Name): SEAN TYLER KITCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
N CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

V. Phone/Fax

Practice location:
  • Phone: 843-797-7000
  • Fax:
Mailing address:
  • Phone: 828-257-4472
  • Fax: 828-258-2097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD37085
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD37085
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD37085
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number2017-00650
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: