Individual
BRIAN KENT HEABERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
146 E HOSPITAL DR STE 200, WEST COLUMBIA, SC 29169-4800
(803) 936-7530
(803) 936-7532
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
52550
SC
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
TMP - 01602
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2442280
—
OH
05
—
3810005836
—
WV
01
—
P00335936
RAILROAD
—
Enumeration date
07/12/2006
Last updated
11/06/2020
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