Healthcare Provider Details

I. General information

NPI: 1811000177
Provider Name (Legal Business Name): CHARLESTON RADIOLOGISTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 WOODLAND AVENUE
MOUNT PLEASANT SC
29464
US

IV. Provider business mailing address

1241 WOODLAND AVENUE
MOUNT PLEASANT SC
29464
US

V. Phone/Fax

Practice location:
  • Phone: 843-824-0606
  • Fax: 843-824-0909
Mailing address:
  • Phone: 800-922-0346
  • Fax: 843-569-8542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA HUDSON
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 843-824-0606