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General NPI Number Information
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NPI Number | 1417317264
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Entity Type | Organization
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Legal Business Name | THOMAS J CARZOLI MD PA
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 1301 TAYLOR ST SUITE 5K
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City | COLUMBIA
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State | SC
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Zip | 29201-2942
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Country | US
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Telephone | 803-765-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 1301 TAYLOR ST SUITE 5K
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City | COLUMBIA
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State | SC
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Zip | 29201-2942
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Country | US
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Telephone | 803-765-2090
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | TAMMY B WILLARD
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Credential |
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Telephone | 803-765-2090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 2580
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License Number State | SC
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