Healthcare Provider Details

I. General information

NPI: 1811004179
Provider Name (Legal Business Name): KEVIN KING ROGGIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 JONATHAN LUCAS ST
CHARLESTON SC
29425-1443
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-4268
  • Fax: 843-876-3046
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD90672
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: