Individual
THOMAS LESTER KLVANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
10 E HOSPITAL ST, HOSPITALIST DEPARTMENT, MANNING, SC 29102-3153
(803) 435-8463
(803) 435-5288
Mailing address
10 E HOSPITAL ST, HOSPITALIST DEPARTMENT, MANNING, SC 29102-3153
(803) 435-8463
(803) 435-5288
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TL 1546
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TL 1546
PA LICENSE
SC
Enumeration date
08/26/2010
Last updated
11/19/2014
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