Basic Information
| Provider Information | |||||||||
| NPI: | 1154300424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HASKINS | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1124 SAM RITTENBERG BLVD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294073362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435563462 | ||||||||
| FaxNumber: | 8437662103 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 FOLLY RD STE A | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294122625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437955362 | ||||||||
| FaxNumber: | 8437951921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 15474 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080077152 | 01 | SC | RR MEDICARE | OTHER | P00797258 | 01 | SC | RAILROAD MC ID-RSFPN | OTHER | 154745 | 05 | SC | MEDICAID | 080180693 | 01 | SC | RR MEDICARE | OTHER | E91151A634 | 01 | SC | MEDICARE PIN | OTHER |