Provider Demographics
NPI:1144280710
Name:HWANG, TE-LONG (MD)
Entity type:Individual
Prefix:DR
First Name:TE-LONG
Middle Name:
Last Name:HWANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 420, 8 MEDICAL PARK
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-545-6050
Mailing Address - Fax:803-545-6051
Practice Address - Street 1:3390 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 420, 8 MEDICAL PARK
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8003
Practice Address - Country:US
Practice Address - Phone:803-545-6050
Practice Address - Fax:803-545-6051
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC138122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC138121Medicaid
SC138121Medicaid
D75075Medicare UPIN
SCD750754411Medicare PIN