Individual
IRA R WILLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0001
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
19715
SC
207RI0008X
Hepatology Physician
19715
SC
207RT0003X
Transplant Hepatology Physician
Primary
19715
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T37715
—
SC
Enumeration date
08/29/2006
Last updated
03/02/2022
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