MEDICARE: SALVATORE C ASSORGI, DO MEDICAL PRACTICE, LLC

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	207Q00000X	Family Medicine Physician	731	SC

General Provider Information

NPI Number	:	1457532061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALVATORE C ASSORGI, DO MEDICAL PRACTICE, LLC

Provider Business Mailing Address
First Line	:	30 PROFESSIONAL VILLAGE CIR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-1570
Country	:	US
Telephone Number	:	843-522-1203
Fax Number	:	843-522-1914

Provider Business Practice Location Address
First Line	:	30 PROFESSIONAL VILLAGE CIR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-1570
Country	:	US
Telephone Number	:	843-522-1203
Fax Number	:	843-522-1914

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SALVATORE C ASSORGI
Credential	:	DO
Telephone Number	:	843-522-1203

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	12/05/2007

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