Provider Demographics
NPI:1558300525
Name:CHARLESTON PATHOLOGY, P.A.
Entity Type:Organization
Organization Name:CHARLESTON PATHOLOGY, P.A.
Other - Org Name:COASTAL PATHOLOGY LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRANAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-442-8365
Mailing Address - Street 1:125 DOUGHTY STREET
Mailing Address - Street 2:STE 480
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403
Mailing Address - Country:US
Mailing Address - Phone:843-769-6345
Mailing Address - Fax:843-769-7614
Practice Address - Street 1:125 DOUGHTY STREET
Practice Address - Street 2:STE 480
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403
Practice Address - Country:US
Practice Address - Phone:843-769-6345
Practice Address - Fax:843-769-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8966207ZC0500X, 207ZP0102X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Single Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCL00103Medicaid
SCL00103Medicaid
SC690009224Medicare PIN