Provider Demographics
NPI:1689601189
Name:CHARLESTON PLASTIC SURGERY
Entity Type:Organization
Organization Name:CHARLESTON PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-722-1985
Mailing Address - Street 1:261 CALHOUN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1371
Mailing Address - Country:US
Mailing Address - Phone:843-722-1985
Mailing Address - Fax:
Practice Address - Street 1:261 CALHOUN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1371
Practice Address - Country:US
Practice Address - Phone:843-722-1985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA6840Medicaid
SC1405Medicare ID - Type UnspecifiedGROUP NUMBER