Provider Demographics
NPI:1871676684
Name:SCARLETT, LESLIE CHARDKOFF (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CHARDKOFF
Last Name:SCARLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2861 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9172
Mailing Address - Country:US
Mailing Address - Phone:843-820-2020
Mailing Address - Fax:843-735-6211
Practice Address - Street 1:2861 TRICOM ST
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9172
Practice Address - Country:US
Practice Address - Phone:843-820-2020
Practice Address - Fax:843-735-6211
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24449207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC244499Medicaid
SC244499Medicaid
5911Medicare PIN
5912Medicare PIN
5910Medicare PIN
5909Medicare PIN