=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881734226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LOWCOUNTRY PODIATRY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 12/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55B SHERIDAN PARK CIR
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29910-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-815-5092
-----------------------------------------------------
Fax | 843-815-5094
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55B SHERIDAN PARK CIR
-----------------------------------------------------
City | BLUFFTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29910-6025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-815-5092
-----------------------------------------------------
Fax | 843-815-5094
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SEAN EDWARD VANMARTER
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 843-815-5092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 511
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------