Healthcare Provider Details

I. General information

NPI: 1134780463
Provider Name (Legal Business Name): BRIGITTE JAHOOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 MAGNOLIA ST
ORANGEBURG SC
29115-1466
US

IV. Provider business mailing address

3310 MAGNOLIA ST
ORANGEBURG SC
29115-1466
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-6900
  • Fax: 803-531-6907
Mailing address:
  • Phone: 803-531-6900
  • Fax: 803-531-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number88603
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: