Healthcare Provider Details

I. General information

NPI: 1558300525
Provider Name (Legal Business Name): CHARLESTON PATHOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 DOUGHTY STREET STE 480
CHARLESTON SC
29403
US

IV. Provider business mailing address

125 DOUGHTY STREET STE 480
CHARLESTON SC
29403
US

V. Phone/Fax

Practice location:
  • Phone: 843-769-6345
  • Fax: 843-769-7614
Mailing address:
  • Phone: 843-769-6345
  • Fax: 843-769-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number8966
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number8966
License Number StateSC

VIII. Authorized Official

Name: MRS. SUSAN M BRANAND
Title or Position: PRACTICE MANAGER
Credential:
Phone: 843-442-8365