Healthcare Provider Details

I. General information

NPI: 1093358483
Provider Name (Legal Business Name): MARY BELLINGER KLAUBER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 CHARLIE HALL BLVD UNIT B
CHARLESTON SC
29414-6099
US

IV. Provider business mailing address

1938 CHARLIE HALL BLVD UNIT B
CHARLESTON SC
29414-6099
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-0227
  • Fax: 843-402-0232
Mailing address:
  • Phone: 843-402-0227
  • Fax: 843-402-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5766
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: