Provider Demographics
NPI:1235161274
Name:CIFUENTES, EDUARDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:CIFUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 SPEISSEGGER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8299
Mailing Address - Country:US
Mailing Address - Phone:843-745-5153
Mailing Address - Fax:843-766-8606
Practice Address - Street 1:2777 SPEISSEGGER DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8229
Practice Address - Country:US
Practice Address - Phone:843-745-5153
Practice Address - Fax:843-766-8606
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC267792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC267794Medicaid
SCAA0505Medicare PIN
SC267794Medicaid
SCI11660Medicare UPIN