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Organization
CONWAY PEDIATRICS,PA
Active
Organization
CONWAY PEDIATRICS,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS PETRUSICK MD (DOCTOR)
(843) 248-2727
Entity
Organization
Contact information
Practice address
907 BELL ST, CONWAY, SC 29526-4113
(843) 248-2727
(843) 248-5107
Mailing address
907 BELL ST, CONWAY, SC 29526-4113
(843) 248-2727
(843) 248-5107
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
4548
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RHC063
—
SC
Enumeration date
07/19/2006
Last updated
02/20/2014
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