Healthcare Provider Details

I. General information

NPI: 1467256537
Provider Name (Legal Business Name): CHARLES LEE COSTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RICHLAND MEDICAL PARK DR STE 300
COLUMBIA SC
29203-6869
US

IV. Provider business mailing address

9 RICHLAND MEDICAL PARK DR STE 200A
COLUMBIA SC
29203-6859
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-6155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL93972
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: