Provider Demographics
NPI:1922110170
Name:PARKER, TELFAIR H (MD)
Entity Type:Individual
Prefix:DR
First Name:TELFAIR
Middle Name:H
Last Name:PARKER
Suffix:
Gender:M
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:510 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7540
Practice Address - Country:US
Practice Address - Phone:843-723-6426
Practice Address - Fax:843-722-2193
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC077062Medicaid
SCC605899223Medicare PIN
SCC605891312Medicare PIN
SC077062Medicaid