Healthcare Provider Details

I. General information

NPI: 1255499950
Provider Name (Legal Business Name): ROBERT WOZNIAK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 S HERLONG AVE SUITE 106
ROCK HILL SC
29732-8349
US

IV. Provider business mailing address

410 S HERLONG AVE SUITE 106
ROCK HILL SC
29732-8349
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-3899
  • Fax: 803-329-4377
Mailing address:
  • Phone: 803-329-3899
  • Fax: 803-329-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21019
License Number StateSC

VIII. Authorized Official

Name: DR. ROBERT WOZNIAK
Title or Position: PRESIDENT
Credential: MD
Phone: 803-329-3899