Provider Demographics
NPI:1154480366
Name:SEASIDE PEDIATRICS OF BLUFFTON, PC
Entity Type:Organization
Organization Name:SEASIDE PEDIATRICS OF BLUFFTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:MOOSBRUGGER
Authorized Official - Last Name:BERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-757-8663
Mailing Address - Street 1:167 BLUFFTON RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6227
Mailing Address - Country:US
Mailing Address - Phone:843-757-8663
Mailing Address - Fax:843-815-3849
Practice Address - Street 1:167 BLUFFTON RD
Practice Address - Street 2:SUITE G, BOX 7
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6227
Practice Address - Country:US
Practice Address - Phone:843-757-8663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27781208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty