Provider Demographics
NPI:1609825561
Name:PALMETTO PULMONARY PHYSICIANS OF CHARLESTON PA
Entity Type:Organization
Organization Name:PALMETTO PULMONARY PHYSICIANS OF CHARLESTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:FECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-795-1025
Mailing Address - Street 1:105 WAPPOO CREEK DR
Mailing Address - Street 2:SUITE 3-A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2134
Mailing Address - Country:US
Mailing Address - Phone:843-795-1025
Mailing Address - Fax:843-795-1081
Practice Address - Street 1:105 WAPPOO CREEK DR
Practice Address - Street 2:SUITE 3-A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2134
Practice Address - Country:US
Practice Address - Phone:843-795-1025
Practice Address - Fax:843-795-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10847207R00000X, 207RE0101X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2299Medicaid
SCGP2299Medicaid
SCB92263Medicare UPIN