Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 00349 | SC |
NPI | 1982754867 |
---|---|
Provider Name | Dr. Carol Eleanor Benoit-Fischer |
First Address | North Charleston, SC 29420-4282 |
Second Address | North Charleston, SC 29420-4282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64738 | (02) | SC |
TL0460 | (05) | SC |