Organization
GRAND STRAND PEDIATRICS & ADOLESCENT MEDICINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS W PETRUSICK MD (OWNER/PHYSICIAN)
(843) 449-1438
Entity
Organization
Contact information
Practice address
8120 ROURK ST, MYRTLE BEACH, SC 29572-4127
(843) 449-1438
(843) 286-1349
Mailing address
8120 ROURK ST, MYRTLE BEACH, SC 29572-4127
(843) 449-1438
(843) 286-1349
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
7085
SC
Other
Enumeration date
05/12/2006
Last updated
02/25/2014
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