MEDICARE: CHRISTY CHALEB ROBERTS P.A C

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	363A00000X	Physician Assistant	962	SC

General Provider Information

NPI Number	:	1972676625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY CHALEB ROBERTS P.A C

Provider Business Mailing Address
First Line	:	776 DANIEL ELLIS DRIVE
Second Line	:	UNIT 1 A
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3034
Country	:	US
Telephone Number	:	843-723-6529
Fax Number	:	843-200-0562

Provider Business Practice Location Address
First Line	:	776 DANIEL ELLIS DRIVE
Second Line	:	UNIT 1 A
City	:	CHARLESTON
State	:	SC
Zip	:	29412-3034
Country	:	US
Telephone Number	:	843-723-6529
Fax Number	:	843-200-0562

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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