Healthcare Provider Details

I. General information

NPI: 1558479519
Provider Name (Legal Business Name): ANN E SURPRENANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN E DARGAN-MCDONALD MD

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5133 RIVERS AVE
NORTH CHARLESTON SC
29406-6338
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-789-1786
  • Fax: 843-958-1263
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2009-00576
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number33792
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number33792
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: