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General NPI Number Information
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NPI Number | 1639128671
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Entity Type | Organization
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Legal Business Name | CHARLESTON NEUROSURGICAL
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 9275 MEDICAL PLAZA DR STE B
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City | N CHARLESTON
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State | SC
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Zip | 29406-9140
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Country | US
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Telephone | 843-553-9300
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Fax | 843-569-7651
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Provider Business Mailing Address
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Address Line | 9275 MEDICAL PLAZA DR STE B
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City | N CHARLESTON
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State | SC
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Zip | 29406-9140
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Country | US
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Telephone | 843-553-9300
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Fax | 843-569-7651
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ROBERT A FAILE III
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Credential | MHA
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Telephone | 843-723-8823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 7798
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License Number State | SC
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