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Organization

COASTAL CAROLINA NEPHROLOGY LLC

Active
Other names
Trident Nephrology LLC
Organization subpart
No

Provider details

NPI number
Authorized official
MS. LISA R STEWART MD (PARTNER)
(843) 554-9313
Entity
Organization

Contact information

Practice address
1938-A CHARLIE HALL BLVD, CHARLESTON, SC 29414-5837
(843) 554-9313
(843) 744-5961
Mailing address
1938-A CHARLIE HALL BLVD, CHARLESTON, SC 29414-5837
(843) 554-9313
(843) 744-5961

Taxonomy

Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
8172
MEDICARE GROUP
01
GP2967
MEDICAID GROUP
Enumeration date
11/07/2005
Last updated
08/29/2007
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