Provider Demographics
NPI:1124226006
Name:GLEATON, DOUGLAS HAROLD II (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HAROLD
Last Name:GLEATON
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 13955
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-225-8320
Mailing Address - Fax:843-225-3549
Practice Address - Street 1:1064 GARDNER RD STE 105-106
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:854-429-1175
Practice Address - Fax:843-695-9467
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2019-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC30062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA7626A634OtherMEDICARE PTAN
SC300622Medicaid
SCP00982686OtherRAILROAD MEDICARE ID-RSFPN