MEDICARE: DR. KENOSHA D GLEATON MD

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
1	207V00000X	Obstetrics & Gynecology Physician	32540	SC
2	207V00000X	Obstetrics & Gynecology Physician	135029	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1235268210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENOSHA D GLEATON MD

Provider Business Mailing Address
First Line	:	2048 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5830
Country	:	US
Telephone Number	:	843-804-6010
Fax Number	:	843-804-6011

Provider Business Practice Location Address
First Line	:	2048 CHARLIE HALL BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5830
Country	:	US
Telephone Number	:	843-804-6010
Fax Number	:	843-804-6011

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	03/04/2021

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