1144292624 NPI number — GAYLE SERAFINI RICHMOND MD

Table of content: GAYLE SERAFINI RICHMOND MD (NPI 1144292624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144292624 NPI number — GAYLE SERAFINI RICHMOND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHMOND
Provider First Name:
GAYLE
Provider Middle Name:
SERAFINI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144292624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 421718
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29442-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-527-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4017 HIGHWAY 17 BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576-2674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-651-6525
Provider Business Practice Location Address Fax Number:
843-357-5035
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  12203 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12203 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89066TG , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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