Provider Demographics
NPI:1265458251
Name:SEASHORE PEDIATRICS
Entity Type:Organization
Organization Name:SEASHORE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SEASHORE PEDIATRICS PC
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:NILES
Authorized Official - Last Name:LUDLOW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-716-2229
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-0669
Mailing Address - Country:US
Mailing Address - Phone:843-716-2229
Mailing Address - Fax:843-716-2483
Practice Address - Street 1:3109 CASEY ST
Practice Address - Street 2:BOX 669
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2807
Practice Address - Country:US
Practice Address - Phone:843-716-2229
Practice Address - Fax:843-716-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901589Medicaid
SCGP 3483Medicaid