Provider Demographics
NPI:1659302602
Name:CHARLESTON PSYCHIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:CHARLESTON PSYCHIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-556-5502
Mailing Address - Street 1:PO BOX 14035
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-4035
Mailing Address - Country:US
Mailing Address - Phone:843-556-5502
Mailing Address - Fax:843-556-0300
Practice Address - Street 1:655 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7165
Practice Address - Country:US
Practice Address - Phone:843-556-5502
Practice Address - Fax:843-556-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3251Medicaid