Organization
PEDIATRIX MEDICAL GROUP OF SOUTH CAROLINA PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLAS E GLASER (ASSISTANT SECRETARY)
(954) 384-0175
Entity
Organization
Contact information
Practice address
1301 CONCORD TER, SUNRISE, FL 33323-2843
(954) 384-0175
(954) 851-1948
Mailing address
4991 LAKE BROOK DR, SUITE 300, GLEN ALLEN, VA 23060-9293
(804) 346-3535
(804) 253-0408
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP0179
—
SC
05
—
GP1787
—
SC
05
—
GP2096
—
SC
05
—
GP2351
—
SC
05
—
GP2505
—
SC
05
—
GP2701
—
SC
05
—
GP3250
—
SC
05
—
GP3457
—
SC
05
—
GP3458
—
SC
05
—
GP3519
—
SC
Enumeration date
09/17/2006
Last updated
11/12/2024
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