Individual
TINA M BOTELHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 LONG POINT RD # 100, MOUNT PLEASANT, SC 29464-8000
(843) 606-9199
(843) 718-2858
Mailing address
550 LONG POINT RD # 100, MOUNT PLEASANT, SC 29464-8000
(843) 606-9199
(843) 718-2858
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25344
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253442
—
SC
01
—
571020809012
BCBS SC
SC
01
—
571020809058
TRICARE SC
SC
01
—
A913
TINA BOTELHO MD PTAN ASSOCIATED LEGACY INTERNAL MEDICINE LLC
SC
01
—
AA8570A913
LEGACY INTERNAL MEDICINE LLC--GROUP PTAN
SC
01
—
P00202158
RR MEDICARE
SC
01
—
P00802342
RR MEDICARE
SC
Enumeration date
06/23/2006
Last updated
04/15/2025
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