Provider Demographics
NPI:1548534381
Name:PIEHOTA, PHELAN GILES (DO)
Entity type:Individual
Prefix:
First Name:PHELAN
Middle Name:GILES
Last Name:PIEHOTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9565 HIGHWAY 78
Mailing Address - Street 2:BLDG 200
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4118
Mailing Address - Country:US
Mailing Address - Phone:843-553-2477
Mailing Address - Fax:
Practice Address - Street 1:9565 HIGHWAY 78
Practice Address - Street 2:BLDG 200
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4118
Practice Address - Country:US
Practice Address - Phone:843-553-2477
Practice Address - Fax:843-553-2478
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017900207W00000X
SC83038207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology