Provider Demographics
NPI:1225077134
Name:LIVINGSTON, RUTH LEVERN (MD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:LEVERN
Last Name:LIVINGSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1 BISHOP GADSDEN WAY STE 97
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3506
Practice Address - Country:US
Practice Address - Phone:843-402-2362
Practice Address - Fax:843-606-8082
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080178546OtherRR MEDICARE
SCP00727207OtherRAILROAD MEDICARE ID-RSFPN
SC115413Medicaid
SCP00011989OtherRR MEDICARE
SC1497874424Medicare PIN
SC080178546OtherRR MEDICARE
SC115413Medicaid
SCD90820Medicare UPIN
SCP00011989OtherRR MEDICARE
SCD908204887Medicare PIN