Provider Demographics
NPI:1861449688
Name:LOWCOUNTRY RADIATION ONCOLOGY, PA
Entity type:Organization
Organization Name:LOWCOUNTRY RADIATION ONCOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DECKER
Authorized Official - Last Name:MULBRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-724-2140
Mailing Address - Street 1:PO BOX 63345
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-0001
Mailing Address - Country:US
Mailing Address - Phone:843-724-2140
Mailing Address - Fax:
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1113
Practice Address - Country:US
Practice Address - Phone:843-724-2140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4262Medicaid
SCDE4060OtherRAILROAD MEDICARE
SCGP4262Medicaid
SC8369Medicare PIN