Organization
MEDICAL UNIVERSITY HOSPITAL AUTHORITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARYN RAE (DIRECTOR)
(843) 876-1344
Entity
Organization
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751514, CHARLOTTE, NC 28275-1514
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DRC007
—
SC
Enumeration date
01/16/2007
Last updated
11/30/2011
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