Provider Demographics
NPI:1275582397
Name:HAUSLADEN, EDWARD H (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:HAUSLADEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:554 MEMORIAL DRIVE EXT
Practice Address - Street 2:SUITE C
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1155
Practice Address - Country:US
Practice Address - Phone:864-879-3883
Practice Address - Fax:864-848-3492
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC153522080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC153522Medicaid
SC153522Medicaid
SCAA35727951Medicare PIN