Healthcare Provider Details

I. General information

NPI: 1578570107
Provider Name (Legal Business Name): SETH P KUPFERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 MEDCOM ST
N CHARLESTON SC
29406
US

IV. Provider business mailing address

9100 MEDCOM ST
N CHARLESTON SC
29406
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-3367
  • Fax: 843-764-3577
Mailing address:
  • Phone: 843-569-3367
  • Fax: 843-764-3577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number14913
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: