Provider Demographics
NPI:1528385846
Name:CHARLESTON UROLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:CHARLESTON UROLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APPOINTED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-884-8045
Mailing Address - Street 1:180 WINGO WAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1810
Mailing Address - Country:US
Mailing Address - Phone:843-884-8045
Mailing Address - Fax:843-881-5081
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-8045
Practice Address - Fax:843-881-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty