Provider Demographics
NPI:1649408097
Name:CASEBOLT, CONSTANCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:E
Last Name:CASEBOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HALTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3496
Mailing Address - Country:US
Mailing Address - Phone:864-558-0200
Mailing Address - Fax:864-520-1245
Practice Address - Street 1:301 HALTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3496
Practice Address - Country:US
Practice Address - Phone:864-558-0200
Practice Address - Fax:864-520-1245
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC14652OtherLICENSE