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NPI Code Detail

MEDICARE: ETTALEAH BLUESTEIN M.D.

MEDICARE: ETTALEAH BLUESTEIN 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
1207W00000XOphthalmology Physician15521SC

Other Identifiers

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

General Provider Information

NPI Number : 1720030836
Entity Type Code : Organization
Provider Name (Legal Business Name) : ETTALEAH BLUESTEIN M.D.
Provider Business Mailing Address
First Line : 2287 HENRY TECKLENBURG DR
Second Line : SUITE 1
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-769-6655
Fax Number : 843-769-6866
Provider Business Practice Location Address
First Line : 2287 HENRY TECKLENBURG DR
Second Line : SUITE 1
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-769-6655
Fax Number : 843-769-6866
Authorized Official
Title or Position : DOCTOR
Name : ETTALEAH BLUESTEIN
Credential : M.D.
Telephone Number : 843-769-6655
Provider Enumeration Date : 05/17/2006
Last Update Date : 03/04/2013

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