Provider Demographics
NPI:1750771705
Name:CHARLESTON MATERNAL FETAL MEDICINE LLC
Entity type:Organization
Organization Name:CHARLESTON MATERNAL FETAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-437-0406
Mailing Address - Street 1:2095 HENRY TECKLENBURG DR
Mailing Address - Street 2:ROOM 100
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5733
Mailing Address - Country:US
Mailing Address - Phone:843-402-2028
Mailing Address - Fax:
Practice Address - Street 1:2095 HENRY TECKLENBURG DR
Practice Address - Street 2:ROOM 100
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5733
Practice Address - Country:US
Practice Address - Phone:843-402-2028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty