| Mountain Laurel Internal Medicine | |
|
1510 Blue Ridge Blvd Ste 105 Seneca SC 29672-6684 | |
| (864) 722-5315 | |
| Not Available |
| Full Name | Mountain Laurel Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 1510 Blue Ridge Blvd Ste 105, Seneca, South Carolina |
| Authorized Official Name and Position | David Liebman (OWNER) |
| Authorized Official Contact | 8647225915 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Laurel Internal Medicine 1510 Blue Ridge Blvd Ste 105 Seneca SC 29672-6684 Ph: (864) 722-5315 | Mountain Laurel Internal Medicine 1510 Blue Ridge Blvd Ste 105 Seneca SC 29672-6684 Ph: (864) 722-5315 |
| NPI Number | 1932695848 |
|---|---|
| Provider Enumeration Date | 07/03/2018 |
| Last Update Date | 07/03/2018 |
| Medicare PECOS PAC ID | 1658623954 |
|---|---|
| Medicare Enrollment ID | O20181016000325 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932695848 | NPI | - | NPPES |
| T30712 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 19038 (South Carolina) | Primary |
| Provider Name | David Liebman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649234261 PECOS PAC ID: 9032240098 Enrollment ID: I20100708000534 |
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