MEDICARE: PALMETTO PLASTIC SURGERY, P.A.

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	208200000X	Plastic Surgery Physician

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	:	1811953847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PLASTIC SURGERY, P.A.

Provider Business Mailing Address
First Line	:	2801 TRICOM ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9172
Country	:	US
Telephone Number	:	843-797-5252
Fax Number	:	843-797-3683

Provider Business Practice Location Address
First Line	:	2801 TRICOM ST
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9172
Country	:	US
Telephone Number	:	843-797-5252
Fax Number	:	843-797-3683

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. KAREN WEINER
Credential	:
Telephone Number	:	843-797-5252

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/07/2008

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