Provider Demographics
NPI:1659576114
Name:WILLIAM J GROSSMAN MD PA
Entity Type:Organization
Organization Name:WILLIAM J GROSSMAN MD PA
Other - Org Name:CHARLESTON CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-723-1614
Mailing Address - Street 1:191 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5822
Mailing Address - Country:US
Mailing Address - Phone:843-723-1614
Mailing Address - Fax:843-727-2980
Practice Address - Street 1:191 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5822
Practice Address - Country:US
Practice Address - Phone:843-723-1614
Practice Address - Fax:843-727-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6926174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2283Medicaid
SCPA2283Medicaid