Provider Demographics
NPI:1578671525
Name:O'BRIEN, TERRENCE X (MD, MS, FACC)
Entity type:Individual
Prefix:
First Name:TERRENCE
Middle Name:X
Last Name:O'BRIEN
Suffix:
Gender:M
Credentials:MD, MS, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-1414
Mailing Address - Fax:
Practice Address - Street 1:135 RUTLEDGE ST STE 1201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8903
Practice Address - Country:US
Practice Address - Phone:843-792-2295
Practice Address - Fax:843-792-7771
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16785207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC167857Medicaid
SCD90897Medicare ID - Type Unspecified
SC167857Medicaid