Provider Demographics
NPI:1245307578
Name:EDGERTON, COLIN CLARK (MD)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:CLARK
Last Name:EDGERTON
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 1:2001 2ND AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7881
Mailing Address - Country:US
Mailing Address - Phone:843-572-4840
Mailing Address - Fax:
Practice Address - Street 1:2001 2ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486
Practice Address - Country:US
Practice Address - Phone:843-572-4840
Practice Address - Fax:843-793-6156
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22460207RR0500X
SC35120207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology