Widenhouse, Brian Glenn

Widenhouse, Brian Glenn is an individual health care provider with primary practice located at 2683 Lake Park Dr , North Charleston SC 29406-9100. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as his primary health care specialty. Widenhouse, Brian Glenn can be contacted via phone (843) 518-5000.

Contact Information

Primary practice address
2683 Lake Park Dr North Charleston SC 29406-9100
Phone: (843) 518-5000
Fax: (843) 614-8959
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 20096 South Carolina

Profile Details

NPI number 1265481543
LBN Legal business name Widenhouse, Brian Glenn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 6th, 2006
Last updated Apr 3rd, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265481543 NPPES
South Carolina MEDICAID 200963

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