Provider Demographics
NPI:1124281688
Name:ITHARAT, PRAT (MD)
Entity type:Individual
Prefix:DR
First Name:PRAT
Middle Name:
Last Name:ITHARAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:515 CARNES CROSSING BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486
Mailing Address - Country:US
Mailing Address - Phone:843-259-2002
Mailing Address - Fax:843-259-2005
Practice Address - Street 1:515 CARNES CROSSING BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486
Practice Address - Country:US
Practice Address - Phone:843-259-2002
Practice Address - Fax:843-259-2005
Is Sole Proprietor?:No
Enumeration Date:2008-07-05
Last Update Date:2017-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCMMD.3132207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology