Provider Demographics
NPI:1518934587
Name:BRYAN, CHARLES STONE
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STONE
Last Name:BRYAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6808
Mailing Address - Country:US
Mailing Address - Phone:803-540-1000
Mailing Address - Fax:803-540-1079
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:SUITE 502
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-540-1079
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7126207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC071264Medicaid
SC071264Medicaid
D17774Medicare UPIN
SCD177742603Medicare PIN