1205696994 NPI number — ELIZABETH GRESHAM SEARS DO

Table of content: ELIZABETH GRESHAM SEARS DO (NPI 1205696994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205696994 NPI number — ELIZABETH GRESHAM SEARS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEARS
Provider First Name:
ELIZABETH
Provider Middle Name:
GRESHAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRESHAM
Provider Other First Name:
MARY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205696994
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TRIDENT MEDICAL CENTER
Provider Second Line Business Mailing Address:
9225 UNIVERSITY BLVD., STE. E2A
Provider Business Mailing Address City Name:
NORTH CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRIDENT MEDICAL CENTER
Provider Second Line Business Practice Location Address:
9225 UNIVERSITY BLVD., STE. E2A
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
842-998-1222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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