Provider Demographics
NPI:1114012945
Name:NATIONAL ALLERGY ASTHMA & URTICARIA CENTERS OF CHARLESTON PA
Entity Type:Organization
Organization Name:NATIONAL ALLERGY ASTHMA & URTICARIA CENTERS OF CHARLESTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-820-1302
Mailing Address - Street 1:1470 TOBIAS GADSON BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4707
Mailing Address - Country:US
Mailing Address - Phone:843-573-9379
Mailing Address - Fax:843-573-9970
Practice Address - Street 1:7555 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4211
Practice Address - Country:US
Practice Address - Phone:843-573-9379
Practice Address - Fax:843-797-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2509Medicaid
SCGP2509Medicaid
SC=========OtherTAX ID