Individual
DR. NATHAN PAUL VANDERVINNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2000
Mailing address
25 OLD SUMMER HOUSE RD, CHARLESTON, SC 29412-3227
(815) 618-8424
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
83102
SC
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
02005448A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11019228A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015976
—
IN
Enumeration date
05/26/2017
Last updated
03/15/2021
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