Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 060840 | GA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 25829 | SC |
NPI | 1043308448 |
---|---|
Provider Name | Dr. Mark Drury Ghegan |
First Address | Charleston, SC 29407-4726 |
Second Address | Charleston, SC 29407-4726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 27/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
258296 | (05) | SC |