Provider Demographics
NPI:1659307718
Name:ROBERTS, CHARLES STEWART (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEWART
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9313 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9155
Mailing Address - Country:US
Mailing Address - Phone:843-553-5616
Mailing Address - Fax:843-764-2917
Practice Address - Street 1:9313 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 304
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9155
Practice Address - Country:US
Practice Address - Phone:843-553-5616
Practice Address - Fax:843-764-2917
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC15095208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56069Medicare UPIN