Provider Demographics
NPI:1457319378
Name:THE ENDOCRINE CENTER, P.A.
Entity Type:Organization
Organization Name:THE ENDOCRINE CENTER, P.A.
Other - Org Name:THE ENDOCRINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO / VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CONDREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-402-1468
Mailing Address - Street 1:2093 HENRY TECKLENBURG DR
Mailing Address - Street 2:SUITE 308E
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5741
Mailing Address - Country:US
Mailing Address - Phone:843-402-1468
Mailing Address - Fax:866-591-9161
Practice Address - Street 1:2093 HENRY TECKLENBURG DR
Practice Address - Street 2:SUITE 308E
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5741
Practice Address - Country:US
Practice Address - Phone:843-402-1468
Practice Address - Fax:866-591-9161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCA72565Medicare ID - Type UnspecifiedMEDICARE GROUP IDENTIFIER