Provider Demographics
NPI:1538247663
Name:KEARSE, HENRY LEWIS III (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LEWIS
Last Name:KEARSE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:85 SPRINGVIEW LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8119
Mailing Address - Country:US
Mailing Address - Phone:843-876-4400
Mailing Address - Fax:843-821-2668
Practice Address - Street 1:85 SPRINGVIEW LN UNIT C
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8119
Practice Address - Country:US
Practice Address - Phone:843-876-4400
Practice Address - Fax:843-821-2668
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13490207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC134900Medicaid
SC134900Medicaid
D47069Medicare UPIN