MEDICARE: MRS. ERIN COPENHAVER PA-C

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	363A00000X	Physician Assistant	1435	SC
2	363AM0700X	Medical Physician Assistant	1435	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8669	OTHER	SC	8669

General Provider Information

NPI Number	:	1992079545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ERIN COPENHAVER PA-C

Provider Business Mailing Address
First Line	:	82 TRADD ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29401-2534
Country	:	US
Telephone Number	:	917-208-2776
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 HOSPITAL DR STE 150
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3243
Country	:	US
Telephone Number	:	843-375-2210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/29/2012
Last Update Date	:	06/11/2019

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