Provider Demographics
NPI:1437118221
Name:SEA ISLAND CANCER CENTER
Entity Type:Organization
Organization Name:SEA ISLAND CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-521-9879
Mailing Address - Street 1:1680B RIBAUT RD
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-2008
Mailing Address - Country:US
Mailing Address - Phone:843-521-9879
Mailing Address - Fax:
Practice Address - Street 1:1680B RIBAUT RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-2008
Practice Address - Country:US
Practice Address - Phone:843-521-9879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2013Medicaid
SC=========OtherBCBS
SC1209600001Medicare NSC