MEDICARE: DR. CHARLES A BICKERSTAFF JR. MD

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
1	207RG0100X	Gastroenterology Physician	8659	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972584712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES A BICKERSTAFF JR. MD

Provider Business Mailing Address
First Line	:	452 FOLLY RD
Second Line	:	SUITE A
City	:	CHARLESTON
State	:	SC
Zip	:	29412-2641
Country	:	US
Telephone Number	:	843-762-9321
Fax Number	:	843-406-9777

Provider Business Practice Location Address
First Line	:	102 WAPPOO CREEK DR STE 10C
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29412
Country	:	US
Telephone Number	:	843-762-9321
Fax Number	:	843-406-9777

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	08/27/2018

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