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General NPI Number Information
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NPI Number | 1750763157
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Entity Type | Individual
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Provider Name | CARLO NICOLA DE CECCO MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 25 COURTENAY DR MSC 226
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City | CHARLESTON
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State | SC
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Zip | 29425-8911
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Country | US
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Telephone | 843-876-7146
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Fax | 843-876-3157
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Provider Business Mailing Address
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Address Line | 25 COURTENAY DR # DRIVE226
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City | CHARLESTON
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State | SC
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Zip | 29425-8911
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Country | US
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Telephone | 843-876-6146
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Fax | 843-876-3157
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | LL37853
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 079192
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License Number State | GA
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