Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 35610 | SC |
N | 207VG0400X | Gynecologist | 35610 | SC |
NPI | 1063400240 |
---|---|
Provider Name | Dr. Iacob Marcovici |
First Address | Myrtle Beach, SC 29572-4116 |
Second Address | Myrtle Beach, SC 29572-4116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
356108 | (05) | SC |
F29881 | (02) |