Healthcare Provider Details

I. General information

NPI: 1689938979
Provider Name (Legal Business Name): CHRISTOPHER PRESTEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ASHLEY AVE # MSC561
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

1755 CENTRAL PARK RD #3709
CHARLESTON SC
29412-2824
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-8972
  • Fax:
Mailing address:
  • Phone: 734-560-9398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL34998
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: