Provider Demographics
NPI:1255393211
Name:RAINE, CHARLES H (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:H
Last Name:RAINE
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 1765
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1765
Mailing Address - Country:US
Mailing Address - Phone:803-536-6339
Mailing Address - Fax:803-536-6734
Practice Address - Street 1:1146 WARING ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4767
Practice Address - Country:US
Practice Address - Phone:803-536-6339
Practice Address - Fax:803-536-6734
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14660207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146602Medicaid
SC391347385OtherEIN
SC146602Medicaid
SCB559090281Medicare PIN