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NPI Code Detail

MEDICARE: CHARLESTON ENT ASSOCIATES, LLC

MEDICARE: CHARLESTON ENT ASSOCIATES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207YP0228XPediatric Otolaryngology Physician

General Provider Information

NPI Number : 1679161244
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLESTON ENT ASSOCIATES, LLC
Provider Business Mailing Address
First Line : 2295 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-766-7103
Fax Number :
Provider Business Practice Location Address
First Line : 200 ARBOR LAKE DR STE 120
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-4516
Country : US
Telephone Number : 803-457-8120
Fax Number :
Authorized Official
Title or Position : MD
Name : EUGENE G BROWN
Credential :
Telephone Number : 843-763-5342
Provider Enumeration Date : 01/08/2021
Last Update Date : 01/08/2021

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Directions to “CHARLESTON ENT ASSOCIATES, LLC ” Practice Location

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