Provider Demographics
NPI:1497711246
Name:PINTA, CHARLES E JR (ATC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:PINTA
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 TURKEY HILL CT
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8340
Mailing Address - Country:US
Mailing Address - Phone:803-837-0109
Mailing Address - Fax:
Practice Address - Street 1:119 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2407
Practice Address - Country:US
Practice Address - Phone:803-536-5509
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC141OtherSTATE ATHLETIC TRAINER LI