MEDICARE: MOUNT PLEASANT OB/GYN, PA

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	174400000X	Specialist	9290	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548215577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT PLEASANT OB/GYN, PA

Provider Business Mailing Address
First Line	:	1400 HOSPITAL DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3255
Country	:	US
Telephone Number	:	843-884-0301
Fax Number	:	843-884-9620

Provider Business Practice Location Address
First Line	:	1400 HOSPITAL DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3255
Country	:	US
Telephone Number	:	843-884-0301
Fax Number	:	843-884-9620

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. LAURALEE TABAKIAN
Credential	:
Telephone Number	:	843-884-0301

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	08/29/2008

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