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12 Professional Village Cir Ladys Island SC 29907-1569 | |
(843) 524-6829 | |
(843) 524-6820 |
Full Name | |
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Speciality | Internal Medicine |
Location | 12 Professional Village Cir, Ladys Island, South Carolina |
Authorized Official Name and Position | Irina Borissova (MD) |
Authorized Official Contact | 8435246829 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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12 Professional Village Cir Ladys Island SC 29907-1569 Ph: (843) 524-6829 | 12 Professional Village Cir Ladys Island SC 29907-1569 Ph: (843) 524-6829 |
NPI Number | 1285702498 |
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Provider Enumeration Date | 12/04/2006 |
Last Update Date | 02/11/2015 |
Medicare PECOS PAC ID | 2062568942 |
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Medicare Enrollment ID | O20090917000341 |
Identifier | Type | State | Issuer |
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1285702498 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Irina Borissova |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1558301655 PECOS PAC ID: 3173679057 Enrollment ID: I20090917000322 |