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General NPI Number Information
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NPI Number | 1962658740
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM ENDOCRINOLOGY, PA
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 622 TROLLEY RD SUITE 102
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5674
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Country | US
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Telephone | 843-851-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 622 TROLLEY RD SUITE 102
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5674
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Country | US
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Telephone | 843-851-3727
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ORLIN SERGEV
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Credential | MD, PHD
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Telephone | 843-851-3727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28953
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License Number State | SC
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