Healthcare Provider Details

I. General information

NPI: 1376733121
Provider Name (Legal Business Name): CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7510 NORTHFOREST DR
NORTH CHARLESTON SC
29420-4247
US

IV. Provider business mailing address

7510 NORTHFOREST DR
NORTH CHARLESTON SC
29420-4247
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-1600
  • Fax: 843-572-1795
Mailing address:
  • Phone: 843-572-1600
  • Fax: 843-572-1795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLAN D LIEBERMAN
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 843-572-1600