Provider Demographics
NPI:1609821602
Name:NEW HAVEN MEDICAL SERVICES, P.A.
Entity type:Organization
Organization Name:NEW HAVEN MEDICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KENNEDY
Authorized Official - Last Name:KWOFIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-885-2000
Mailing Address - Street 1:115 EAGLES NEST DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-2762
Mailing Address - Country:US
Mailing Address - Phone:864-885-2000
Mailing Address - Fax:864-885-1004
Practice Address - Street 1:115 EAGLES NEST DR
Practice Address - Street 2:SUITE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2762
Practice Address - Country:US
Practice Address - Phone:864-885-2000
Practice Address - Fax:864-885-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4100Medicaid
SCH35767Medicare UPIN
SC8200Medicare ID - Type UnspecifiedGROUP NUMBER