Healthcare Provider Details

I. General information

NPI: 1790758803
Provider Name (Legal Business Name): MARGUERITE MEALOR CARLTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1346 HAILE ST
CAMDEN SC
29020
US

IV. Provider business mailing address

1346 HAILE ST
CAMDEN SC
29020
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-1931
  • Fax: 803-432-1176
Mailing address:
  • Phone: 803-432-1931
  • Fax: 803-432-1176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13479
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: