Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 35710 | SC |
N | 2086S0129X | Vascular Surgeon | C1-0010094 | DE |
NPI | 1114174125 |
---|---|
Provider Name | Dr. Jonathan Kittredge |
First Address | Mount Pleasant, SC 29464-1901 |
Second Address | Mount Pleasant, SC 29464-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2008 |
Last Update Date | 05/09/2016 |