Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | TL30425 | SC |
NPI | 1144403999 |
---|---|
Provider Name | Ibrahim Shatat |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2007 |
Last Update Date | 14/12/2007 |