Individual
TALLULAH HOLMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
710 DEWITT DR, LUGOFF, SC 29078-9069
(803) 438-7566
(803) 438-4371
Mailing address
PO BOX 1259, SENTINEL HEALTH PARTNERS PA, CAMDEN, SC 29021-1259
(803) 713-8350
(803) 713-8433
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16660
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110143766
RAILROAD MEDICARE PIN
SC
05
—
166607
—
SC
01
—
64417
MEDCOST
—
Enumeration date
05/17/2006
Last updated
02/24/2012
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