MEDICARE: DR. RADWAN SAADALLAH HALLABA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	26704	SC

General Provider Information

NPI Number	:	1447221346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RADWAN SAADALLAH HALLABA M.D.

Provider Business Mailing Address
First Line	:	8720 DORCHESTER RD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29420-7303
Country	:	US
Telephone Number	:	843-552-3629
Fax Number	:	843-576-5244

Provider Business Practice Location Address
First Line	:	8720 DORCHESTER RD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29420-7303
Country	:	US
Telephone Number	:	843-552-3629
Fax Number	:	843-576-5244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	05/15/2009

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