Provider Demographics
NPI:1881152627
Name:PEDIATRIC ORTHOPEDICS OF CHARLESTON
Entity type:Organization
Organization Name:PEDIATRIC ORTHOPEDICS OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-823-0800
Mailing Address - Street 1:85 SPRINGVIEW LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8119
Mailing Address - Country:US
Mailing Address - Phone:843-823-0800
Mailing Address - Fax:
Practice Address - Street 1:85 SPRINGVIEW LN UNIT B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8119
Practice Address - Country:US
Practice Address - Phone:516-314-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-12
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty