Provider Demographics
NPI:1619139615
Name:WOOTEN, CAROLINE FELDER (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:FELDER
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LONG POINT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7940
Mailing Address - Country:US
Mailing Address - Phone:843-881-0320
Mailing Address - Fax:843-881-5453
Practice Address - Street 1:570 LONG POINT RD STE 200
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7940
Practice Address - Country:US
Practice Address - Phone:843-881-0320
Practice Address - Fax:843-881-5453
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-00008207N00000X
SC30848207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC308483Medicaid
SCSC13447818OtherMEDICARE INDIVIDUAL PTAN
SCP01290513OtherRAILROAD MEDICARE INDIVIDUAL PTAN
SC30848OtherSC MEDICAL LICENSE