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NPI Code Detail

MEDICARE: CHARLESTON ENT ASSOCIATES LLC

MEDICARE: CHARLESTON ENT ASSOCIATES LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Y00000XOtolaryngology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093237117
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLESTON ENT ASSOCIATES LLC
Provider Business Mailing Address
First Line : 2295 HENRY TECKLENBURG DR
Second Line :
City : CHARLESTON
State : SC
Zip : 29414-7801
Country : US
Telephone Number : 843-766-7103
Fax Number : 843-763-3834
Provider Business Practice Location Address
First Line : 1231 RIBAUT RD
Second Line :
City : BEAUFORT
State : SC
Zip : 29902-6147
Country : US
Telephone Number : 843-525-6662
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : EUGENE G BROWN
Credential : MD
Telephone Number : 843-766-7103
Provider Enumeration Date : 07/11/2017
Last Update Date : 07/11/2017

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Directions to “CHARLESTON ENT ASSOCIATES LLC ” Practice Location

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