Healthcare Provider Details

I. General information

NPI: 1720035603
Provider Name (Legal Business Name): UPSTATE PEDIATRIC PULMONARY SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1089 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

IV. Provider business mailing address

1089 BOILING SPRINGS RD
SPARTANBURG SC
29303-2248
US

V. Phone/Fax

Practice location:
  • Phone: 864-573-6320
  • Fax:
Mailing address:
  • Phone: 864-573-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY J FELDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 864-573-6320