Healthcare Provider Details

I. General information

NPI: 1457319378
Provider Name (Legal Business Name): THE ENDOCRINE CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR SUITE 308E
CHARLESTON SC
29414-5741
US

IV. Provider business mailing address

2093 HENRY TECKLENBURG DR SUITE 308E
CHARLESTON SC
29414-5741
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-1468
  • Fax: 866-591-9161
Mailing address:
  • Phone: 843-402-1468
  • Fax: 866-591-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY K CONDREN
Title or Position: CFO / VICE PRESIDENT
Credential:
Phone: 843-402-1468