Individual
JACQUELINE DALLAIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
169 ASHLEY AVE, CHARLESTON, SC 29425-1059
(843) 792-4500
Mailing address
169 ASHLEY AVENUE, ROOM 202 MAIN HOSPITAL, MSC333, CHARLESTON, SC 29425
(843) 792-4500
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
LL84080
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/21/2017
Last updated
05/19/2020
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