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Organization
COASTAL CAROLINA NEPHROLOGY LLC
Active
Organization
COASTAL CAROLINA NEPHROLOGY LLC
Active
Other names
Trident Nephrology LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA R STEWART MD (PARTNER)
(843) 554-9313
Entity
Organization
Contact information
Practice address
1938-A CHARLIE HALL BLVD, CHARLESTON, SC 29414-5837
(843) 554-9313
(843) 744-5961
Mailing address
1938-A CHARLIE HALL BLVD, CHARLESTON, SC 29414-5837
(843) 554-9313
(843) 744-5961
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8172
MEDICARE GROUP
—
01
—
GP2967
MEDICAID GROUP
—
Enumeration date
11/07/2005
Last updated
08/29/2007
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