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General NPI Number Information
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NPI Number | 1972804888
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Entity Type | Individual
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Provider Name | MARTINE A HUTTON M.D
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Gender | Female
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Dates
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Enumeration Date | 11/09/2010
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 776 DANIEL ELLIS DRIVE SUITE 3C
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-795-0900
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Fax | 843-762-5495
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Provider Business Mailing Address
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Address Line | PO BOX 12159
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City | CHARLESTON
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State | SC
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Zip | 29412
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Country | US
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Telephone | 843-795-0900
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Fax | 843-762-5495
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 09337
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License Number State | SC
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