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General NPI Number Information
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NPI Number | 1306259544
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Entity Type | Organization
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Legal Business Name | PELICAN PEDIATRICS LLC
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 452 FOLLY RD
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-795-3344
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Fax |
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Provider Business Mailing Address
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Address Line | 452 FOLLY RD
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City | CHARLESTON
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State | SC
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Zip | 29412-2641
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Country | US
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Telephone | 843-795-3344
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Fax | 843-795-3143
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. ELIZA VARADI
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Credential | MD
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Telephone | 843-795-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 29944
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License Number State | SC
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