# ETTALEAH BLUESTEIN M.D.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720030836
- **Authorized official:** ETTALEAH BLUESTEIN M.D. (DOCTOR)
- **Authorized official phone:** (843) 769-6655

## Contact information

- **Practice address:** 2287 HENRY TECKLENBURG DR, SUITE 1, CHARLESTON, SC 29414-7801
- **Practice address phone:** (843) 769-6655
- **Practice address fax:** (843) 769-6866
- **Mailing address:** 2287 HENRY TECKLENBURG DR, SUITE 1, CHARLESTON, SC 29414-7801
- **Mailing address phone:** (843) 769-6655
- **Mailing address fax:** (843) 769-6866

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 15521 | SC | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 03/04/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP4400 | — | SC |