Brian Glenn Widenhouse
Plastic and Reconstructive Surgery
2683 Lake Park Dr
North Charleston
, South Carolina 29406-9100
Brian Glenn Widenhouse
Plastic and Reconstructive Surgery
2683 Lake Park Dr
North Charleston
, South Carolina 29406-9100
(843) 614-8959
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Brian Glenn Widenhouse
- 2683 Lake Park Dr
- North Charleston, SC
- Zip : 29406-9100
- Fax : (843) 614-8959
- Phone : (843) 518-5000
Second Address
- Brian Glenn Widenhouse
- 2683 Lake Park Dr
- North Charleston, SC
- Zip : 29406-9100
- Fax : (843) 614-8959
- Phone : (843) 518-5000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | 20096 | SC |
National Provider Identifier
| NPI | 1265481543 |
|---|---|
| Provider Name | Brian Glenn Widenhouse |
| First Address | North Charleston, SC 29406-9100 |
| Second Address | North Charleston, SC 29406-9100 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/05/2006 |
| Last Update Date | 03/04/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 200963 | (05) | SC |
| G68767 | (02) | SC |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.