Provider Demographics
NPI:1659358976
Name:EUSTIS, ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:
Last Name:EUSTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 LONG POINT RD STE 407
Mailing Address - Street 2:
Mailing Address - City:MT. PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8298
Mailing Address - Country:US
Mailing Address - Phone:843-793-9801
Mailing Address - Fax:843-936-4972
Practice Address - Street 1:721 LONG POINT RD
Practice Address - Street 2:STE 407
Practice Address - City:MT. PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8298
Practice Address - Country:US
Practice Address - Phone:843-793-9801
Practice Address - Fax:843-936-4972
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD33183207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659358976OtherNPI
SCP00908557OtherRAILROAD MC ID-RSFPN
SCP00908557OtherRAILROAD MC ID-RSFPN