Provider Demographics
NPI:1861680761
Name:ROBERT E PEYSER MD PA
Entity Type:Organization
Organization Name:ROBERT E PEYSER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-766-3768
Mailing Address - Street 1:1637 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-766-3768
Mailing Address - Fax:843-769-4200
Practice Address - Street 1:1637 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-766-3768
Practice Address - Fax:843-769-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-08-20
Deactivation Date:2008-06-20
Deactivation Code:
Reactivation Date:2008-08-20
Provider Licenses
StateLicense IDTaxonomies
SC113683261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC113683Medicaid
SC113683Medicaid
SCB92344Medicare UPIN