Provider Demographics
NPI:1609320217
Name:CHARLESTON DERMATOLOGY, PC
Entity Type:Organization
Organization Name:CHARLESTON DERMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPERDUTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-872-3015
Mailing Address - Street 1:5401 NETHERBY LANE
Mailing Address - Street 2:STE 1202
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420
Mailing Address - Country:US
Mailing Address - Phone:843-872-3015
Mailing Address - Fax:843-872-3015
Practice Address - Street 1:5401 NETHERBY LANE
Practice Address - Street 2:STE 1202
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420
Practice Address - Country:US
Practice Address - Phone:843-872-3015
Practice Address - Fax:843-872-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty