Provider Demographics
NPI:1356636492
Name:TREMBLAY, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:TREMBLAY
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 1:1101 CLARITY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3138
Mailing Address - Country:US
Mailing Address - Phone:843-606-4990
Mailing Address - Fax:843-375-1480
Practice Address - Street 1:18850 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4288
Practice Address - Country:US
Practice Address - Phone:281-446-7900
Practice Address - Fax:281-446-4879
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMMD 33822207W00000X
SCMMD.33822 LL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5503Medicaid
SCGP2156Medicaid
SCGP2149Medicaid
SCGP2172Medicaid
SC338227Medicaid
SCGP5351Medicaid
SC5909Medicare PIN
SCGP2149Medicaid
SCGP5351Medicaid