Healthcare Provider Details

I. General information

NPI: 1881152627
Provider Name (Legal Business Name): PEDIATRIC ORTHOPEDICS OF CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SPRINGVIEW LN UNIT B
SUMMERVILLE SC
29485-8119
US

IV. Provider business mailing address

85 SPRINGVIEW LN UNIT B
SUMMERVILLE SC
29485-8119
US

V. Phone/Fax

Practice location:
  • Phone: 516-314-7662
  • Fax:
Mailing address:
  • Phone: 843-823-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD LEWIS
Title or Position: OWNER
Credential: MD
Phone: 843-823-0800