Provider Demographics
NPI:1508823444
Name:CARLIN, CHARLES BRETT (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:BRETT
Last Name:CARLIN
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 1:3634 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3052
Mailing Address - Country:US
Mailing Address - Phone:803-926-0969
Mailing Address - Fax:803-926-0757
Practice Address - Street 1:3634 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3052
Practice Address - Country:US
Practice Address - Phone:803-926-0969
Practice Address - Fax:803-926-0757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20801208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF37388Medicare UPIN