Provider Demographics
NPI:1770521361
Name:STAPLES, CHARLES T JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:STAPLES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:TUNE
Other - Last Name:STAPLES
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11450
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685
Mailing Address - Country:US
Mailing Address - Phone:800-509-8138
Mailing Address - Fax:
Practice Address - Street 1:295 MIDLAND PARKWAY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483
Practice Address - Country:US
Practice Address - Phone:843-832-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23845207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC238451Medicaid
SC238451Medicaid
SCH947512986Medicare PIN
SCH947512987Medicare PIN