Provider Demographics
NPI:1881734226
Name:LOWCOUNTRY PODIATRY PA
Entity type:Organization
Organization Name:LOWCOUNTRY PODIATRY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VANMARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:843-815-5092
Mailing Address - Street 1:55B SHERIDAN PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6025
Mailing Address - Country:US
Mailing Address - Phone:843-815-5092
Mailing Address - Fax:843-815-5094
Practice Address - Street 1:55B SHERIDAN PARK CIR
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6025
Practice Address - Country:US
Practice Address - Phone:843-815-5092
Practice Address - Fax:843-815-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC511213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC480028016OtherRAILROAD MEDICARE
SCPD5113Medicaid
SC480028016OtherRAILROAD MEDICARE
SCGP9956Medicaid
SCU67783Medicare UPIN
SC4280860001Medicare NSC