Healthcare Provider Details

I. General information

NPI: 1386488856
Provider Name (Legal Business Name): CHRISTIAN BUCHANAN ROBERTSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 04/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLL92484
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: