Provider Demographics
NPI:1194704130
Name:MCGILL, DOUGLAS EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:MCGILL
Suffix:
Gender:M
Credentials:MD
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 2356
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29465-2356
Mailing Address - Country:US
Mailing Address - Phone:843-568-1001
Mailing Address - Fax:843-277-6446
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:ROPER HOSPITAL
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401
Practice Address - Country:US
Practice Address - Phone:843-971-8376
Practice Address - Fax:843-971-8377
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16425246ZE0600X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG101210281Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
SCG10121Medicare UPIN