Provider Demographics
NPI:1811984966
Name:BURNS, CHARLES PATRICK (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PATRICK
Last Name:BURNS
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 1:341 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4249
Mailing Address - Country:US
Mailing Address - Phone:843-415-5524
Mailing Address - Fax:206-309-7176
Practice Address - Street 1:15 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-3764
Practice Address - Country:US
Practice Address - Phone:843-681-6612
Practice Address - Fax:843-681-6614
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18462207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07164OtherWELLMARK BCBS
IA0071647Medicaid
IA0071647Medicaid
IA110107734Medicare PIN
IA07164Medicare PIN