=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073592937
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INFECTIOUS DISEASES CONSULTANTS & TRAVEL MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2006
-----------------------------------------------------
Last Update Date | 01/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1565 SAM RITTENBERG BLVD STE 200
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-763-6336
-----------------------------------------------------
Fax | 843-571-6194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1565 SAM RITTENBERG BLVD STE 200
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29407-4138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-763-6336
-----------------------------------------------------
Fax | 843-571-6194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MS. TAMI J BARLOW
-----------------------------------------------------
Credential | BS
-----------------------------------------------------
Telephone | 843-763-6336
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------