Provider Demographics
NPI:1457300147
Name:BENSONHAVER, CHARLES LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LAWRENCE
Last Name:BENSONHAVER
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 1:4044 BRIDAL TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-6242
Mailing Address - Country:US
Mailing Address - Phone:843-768-8261
Mailing Address - Fax:843-768-6638
Practice Address - Street 1:4044 BRIDAL TRAIL DR
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-6242
Practice Address - Country:US
Practice Address - Phone:843-768-8261
Practice Address - Fax:843-768-6638
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236062084P0800X
OH350330922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC00888Medicare UPIN