Provider Demographics
NPI:1750763157
Name:DE CECCO, CARLO NICOLA (MD, PHD)
Entity type:Individual
Prefix:
First Name:CARLO
Middle Name:NICOLA
Last Name:DE CECCO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:25 COURTENAY DR # DRIVE226
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8911
Mailing Address - Country:US
Mailing Address - Phone:843-876-6146
Mailing Address - Fax:843-876-3157
Practice Address - Street 1:25 COURTENAY DR
Practice Address - Street 2:MSC 226
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8911
Practice Address - Country:US
Practice Address - Phone:843-876-7146
Practice Address - Fax:843-876-3157
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL378532085R0202X
GA0791922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology