Provider Demographics
NPI:1639391980
Name:TRICOUNTY ENT ASSOCIATES, PA
Entity Type:Organization
Organization Name:TRICOUNTY ENT ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-797-2721
Mailing Address - Street 1:9229 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9150
Mailing Address - Country:US
Mailing Address - Phone:843-797-2721
Mailing Address - Fax:843-797-0271
Practice Address - Street 1:9229 UNIVERSITY BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9150
Practice Address - Country:US
Practice Address - Phone:843-797-2721
Practice Address - Fax:843-797-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6917207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA8027Medicaid
SCC68746Medicare UPIN
SC1966Medicare PIN