Healthcare Provider Details

I. General information

NPI: 1609833516
Provider Name (Legal Business Name): TIMOTHY MICHAEL ZGLESZEWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2679 LAKE PARK DR
NORTH CHARLESTON SC
29406-9100
US

IV. Provider business mailing address

PO BOX 7227
WEST COLUMBIA SC
29171-7227
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-9997
  • Fax: 803-470-4715
Mailing address:
  • Phone: 803-218-9886
  • Fax: 803-470-4715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number78001
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number78001
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number22912
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: