Healthcare Provider Details

I. General information

NPI: 1730566696
Provider Name (Legal Business Name): RUSTIN MEISTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY ST STE 570
CHARLESTON SC
29403-5744
US

IV. Provider business mailing address

125 DOUGHTY ST STE 570
CHARLESTON SC
29403-5744
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2618
  • Fax:
Mailing address:
  • Phone: 843-792-2618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036148949
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD0000057365
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number88381
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: