Provider Demographics
NPI:1295959542
Name:CAROLINA ORTHOPEDIC & PAIN, LLC
Entity type:Organization
Organization Name:CAROLINA ORTHOPEDIC & PAIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-402-9300
Mailing Address - Street 1:2093 HENRY TECKLENBURG DR
Mailing Address - Street 2:303
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5741
Mailing Address - Country:US
Mailing Address - Phone:843-402-9300
Mailing Address - Fax:843-402-9503
Practice Address - Street 1:2093 HENRY TECKLENBURG DR
Practice Address - Street 2:303
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5741
Practice Address - Country:US
Practice Address - Phone:843-402-9300
Practice Address - Fax:843-402-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19929207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC199298Medicaid
SCDO93320281Medicare ID - Type Unspecified
SC199298Medicaid