Provider Demographics
NPI:1164421590
Name:TARBERT, CHARLES E (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:TARBERT
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 1:4615 OLEANDER DR
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5741
Mailing Address - Country:US
Mailing Address - Phone:843-449-9559
Mailing Address - Fax:843-497-6601
Practice Address - Street 1:809 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-497-5929
Practice Address - Fax:843-497-6601
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26998207P00000X
NC200500266207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC269989Medicaid
SC269989Medicaid
NC2045597Medicare PIN
SCH796495373Medicare PIN