Organization
ETTALEAH BLUESTEIN M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ETTALEAH BLUESTEIN M.D. (DOCTOR)
(843) 769-6655
Entity
Organization
Contact information
Practice address
2287 HENRY TECKLENBURG DR, SUITE 1, CHARLESTON, SC 29414-7801
(843) 769-6655
(843) 769-6866
Mailing address
2287 HENRY TECKLENBURG DR, SUITE 1, CHARLESTON, SC 29414-7801
(843) 769-6655
(843) 769-6866
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
15521
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4400
—
SC
Enumeration date
05/17/2006
Last updated
03/04/2013
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