Healthcare Provider Details

I. General information

NPI: 1114128220
Provider Name (Legal Business Name): JOHN V. CUSTER, M.D., L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 POSTON RD SUITE 145
CHARLESTON SC
29407-3424
US

IV. Provider business mailing address

1 POSTON RD SUITE 145
CHARLESTON SC
29407-3424
US

V. Phone/Fax

Practice location:
  • Phone: 843-556-4157
  • Fax: 843-763-8747
Mailing address:
  • Phone: 843-556-4157
  • Fax: 843-763-8747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15084
License Number StateSC

VIII. Authorized Official

Name: JOHN VERNON CUSTER
Title or Position: PARTNER
Credential: M.D.
Phone: 843-556-4157