Provider Demographics
NPI:1659323830
Name:MOAK, DARLENE H (MD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:H
Last Name:MOAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7165
Mailing Address - Country:US
Mailing Address - Phone:843-367-2716
Mailing Address - Fax:843-556-0300
Practice Address - Street 1:669 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:843-367-2716
Practice Address - Fax:843-556-0300
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC142822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC142820Medicaid
SCE938028137Medicare PIN
SCE93802Medicare UPIN