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General NPI Number Information
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NPI Number | 1376518795
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Entity Type | Individual
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Provider Name | EDWIN LEO BLITCH IV DPM
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Gender | Male
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 9313 MEDICAL PLAZA DR 301
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City | CHARLESTON
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State | SC
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Zip | 29406-9155
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Country | US
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Telephone | 843-553-2909
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Fax | 843-553-4684
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Provider Business Mailing Address
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Address Line | 9313 MEDICAL PLAZA DR 301
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City | CHARLESTON
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State | SC
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Zip | 29406-9155
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Country | US
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Telephone | 843-553-2909
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Fax | 843-553-4684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 134
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License Number State | SC
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