Provider Demographics
NPI:1043213622
Name:KOLB, CHARLES A (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:A
Last Name:KOLB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0968
Mailing Address - Country:US
Mailing Address - Phone:864-366-9681
Mailing Address - Fax:864-366-5600
Practice Address - Street 1:901 W GREENWOOD ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5678
Practice Address - Country:US
Practice Address - Phone:864-366-9681
Practice Address - Fax:864-366-5600
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC118660Medicaid
SCD908082811Medicare ID - Type UnspecifiedMEDICARE PROVIDER
SCD90808Medicare UPIN
SC118660Medicaid