Provider Demographics
NPI:1932294766
Name:NATIONAL ALLERGY ASTHMA & URTICARIA CENTERS OF CHARLESTON PA
Entity Type:Organization
Organization Name:NATIONAL ALLERGY ASTHMA & URTICARIA CENTERS OF CHARLESTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-820-1302
Mailing Address - Street 1:730 STONY LANDING RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-2904
Mailing Address - Country:US
Mailing Address - Phone:843-797-8162
Mailing Address - Fax:843-797-8372
Practice Address - Street 1:7555 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-4211
Practice Address - Country:US
Practice Address - Phone:843-797-8162
Practice Address - Fax:843-797-8372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3542Medicaid
SCGP3542Medicaid