Provider Demographics
NPI:1184636565
Name:GRICE, CHARLENE M (MD)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:M
Last Name:GRICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9172
Mailing Address - Country:US
Mailing Address - Phone:843-606-4990
Mailing Address - Fax:843-388-4195
Practice Address - Street 1:242 MATHIS FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-2982
Practice Address - Country:US
Practice Address - Phone:843-606-4990
Practice Address - Fax:843-856-9944
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC13968207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01236580OtherRAILROAD MEDICARE
SC139683Medicaid
SC5909Medicare PIN
SCE81660Medicare UPIN
SC5912Medicare PIN
SC5910Medicare PIN
SCP01236580OtherRAILROAD MEDICARE