Provider Demographics
NPI:1841232501
Name:CHARLESTON OB/GYN, LLC
Entity Type:Organization
Organization Name:CHARLESTON OB/GYN, LLC
Other - Org Name:CHARLESTON OB/GYN, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-740-6700
Mailing Address - Street 1:1027 PHYSICIANS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5351
Mailing Address - Country:US
Mailing Address - Phone:843-740-6700
Mailing Address - Fax:843-745-9428
Practice Address - Street 1:1027 PHYSICIANS DR STE 110
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5351
Practice Address - Country:US
Practice Address - Phone:843-740-6700
Practice Address - Fax:843-745-9428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3554Medicaid
SCCK4839OtherRAILROAD MEDICARE
SCGP3554Medicaid