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Organization

CONWAY PEDIATRICS,PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. THOMAS PETRUSICK MD (DOCTOR)
(843) 248-2727
Entity
Organization

Contact information

Practice address
907 BELL ST, CONWAY, SC 29526-4113
(843) 248-2727
(843) 248-5107
Mailing address
907 BELL ST, CONWAY, SC 29526-4113
(843) 248-2727
(843) 248-5107

Taxonomy

Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
4548
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
RHC063
SC
Enumeration date
07/19/2006
Last updated
02/20/2014
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