Basic Information
| Provider Information | |||||||||
| NPI: | 1215251921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLESTON PAIN CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 MILL ST | ||||||||
| Address2: | STE402 | ||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294644394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438813777 | ||||||||
| FaxNumber: | 8438815777 | ||||||||
| Practice Location | |||||||||
| Address1: | 9263 MEDICAL PLAZA DR | ||||||||
| Address2: | STE B | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294067112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435537070 | ||||||||
| FaxNumber: | 8435532223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2010 | ||||||||
| LastUpdateDate: | 03/24/2010 | ||||||||
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| AuthorizedOfficialLastName: | KARNOFSKY | ||||||||
| AuthorizedOfficialFirstName: | ROBERTA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8438813777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 16473 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.