Individual
DR. ELIZABETH ANN MELLENCAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-0100
(843) 792-2731
Mailing address
169 ASHLEY AVENUE, ROOM 202, MAIN HOSPITAL, MSC333, CHARLESTON, SC 29425
(843) 792-2731
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
LL88073
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL88073
SOUTH CAROLINA LIMITED MEDICAL LICENSE
SC
Enumeration date
06/13/2022
Last updated
06/13/2022
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