MEDICARE: ADVANCED ALLERGY AND ASTHMA, 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	207K00000X	Allergy & Immunology Physician

General Provider Information

NPI Number	:	1861628604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ALLERGY AND ASTHMA, LLC

Provider Business Mailing Address
First Line	:	5401 NETHERBY RD
Second Line	:	SUITE 1200
City	:	N CHARLESTON
State	:	SC
Zip	:	29420-7363
Country	:	US
Telephone Number	:	843-261-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 NETHERBY RD
Second Line	:	SUITE 1200
City	:	N CHARLESTON
State	:	SC
Zip	:	29420-7363
Country	:	US
Telephone Number	:	843-261-2222
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOHN T RAMEY
Credential	:	MD
Telephone Number	:	843-261-2222

Provider Enumeration Date	:	06/08/2009
Last Update Date	:	06/08/2009

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