Provider Demographics
NPI:1184930992
Name:LOWCOUNTRY THORACIC SURGERY ASSOCIATES PA
Entity type:Organization
Organization Name:LOWCOUNTRY THORACIC SURGERY ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-722-3400
Mailing Address - Street 1:1300 HOSPITAL DR STE 360
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7776
Mailing Address - Country:US
Mailing Address - Phone:843-722-3400
Mailing Address - Fax:843-723-7398
Practice Address - Street 1:1300 HOSPITAL DR STE 360
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7776
Practice Address - Country:US
Practice Address - Phone:843-722-3400
Practice Address - Fax:843-723-7398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty