Individual
GEORGE BERNARD DEL PORTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1470 TOBIAS GADSON BLVD, SUITE 201, CHARLESTON, SC 29407-4707
(843) 556-7060
(843) 556-9960
Mailing address
2687 LAKE PARK DR, N CHARLESTON, SC 29406-9100
(843) 572-0097
(843) 725-3118
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
6467
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064673
—
SC
01
—
1633327071
SS NUMBER
SC
01
—
20 4068094
TAX ID
SC
Enumeration date
07/19/2005
Last updated
08/27/2012
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