Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 15352 | SC |
NPI | 1275582397 |
---|---|
Provider Name | Dr. Edward H Hausladen |
First Address | Greenville, SC 29615-4545 |
Second Address | Greer, SC 29651-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 21/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
153522 | (05) | SC |