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NPI Code Detail

MEDICARE: CHARLES EFFIONG MD

MEDICARE: CHARLES EFFIONG 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
1207RN0300XNephrology Physician19174SC
2207R00000XInternal Medicine Physician19174SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2AA83436494OTHERSCMEDICARE PIN FETTER HEALTH CARE NETWORK

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 : 1487604757
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES EFFIONG MD
Provider Business Mailing Address
First Line : P.O. BOX 31093
Second Line :
City : CHARLESTON
State : SC
Zip : 29417
Country : US
Telephone Number : 843-573-0499
Fax Number : 843-388-6292
Provider Business Practice Location Address
First Line : 51 NASSAU ST
Second Line :
City : CHARLESTON
State : SC
Zip : 29403-5513
Country : US
Telephone Number : 843-722-4112
Fax Number : 843-577-8960
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 07/21/2015

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