Healthcare Provider Details

I. General information

NPI: 1215251921
Provider Name (Legal Business Name): CHARLESTON PAIN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 MEDICAL PLAZA DR STE B
CHARLESTON SC
29406-7112
US

IV. Provider business mailing address

410 MILL ST STE402
MT PLEASANT SC
29464-4394
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-7070
  • Fax: 843-553-2223
Mailing address:
  • Phone: 843-881-3777
  • Fax: 843-881-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number16473
License Number StateSC

VIII. Authorized Official

Name: ROBERTA S KARNOFSKY
Title or Position: MANAGING PHYSICIAN
Credential: MD
Phone: 843-881-3777