CHARLESTON BLOOD DISORDERS & CANCER CENTER, P.A. (NPI# 1225120264) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225120264 |
| Entity Type | Organization |
| Organization Name | CHARLESTON BLOOD DISORDERS & CANCER CENTER, P.A. |
| Practice Address |
2093 Henry Tecklenburg Drive Suite318e Charleston SC 29414 |
| Practice Telephone | 8435820266 |
| Practice Fax Number | 8438522025 |
| Mailing Telephone | 8435820266 |
| Mailing Fax Number | 8438522025 |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2010-07-21 |
| Authorized Official Name | DR. ROBERT T WALL JR. (OWNER) |
| Authorized Official Telephone | 8438520266 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 20-11042 | SC | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP3633 | 05 |
| Street Address |
2093 HENRY TECKLENBURG DRIVE SUITE318E |
| City | CHARLESTON |
| State | SC |
| Zip Code | 29414 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902444508 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 3865 West Ashley Circle, Charleston, SC 29414 | 2019-12-13 |
| 1215440169 | Christine Michelle Delcioppo | Nurse Practitioner | 2085 Henry Tecklenburg Dr Fl 2or2, Charleston, SC 29414 | 2017-11-14 |
| 1871013508 | Carolyn Sorenson | Assistant Behavior Analyst | 2218 Hunter Creek Dr, Charleston, SC 29414 | 2017-06-23 |
| 1205387354 | Rachel Klatt | Physical Therapist | 2230 Ashley Crossing Dr., Charleston, SC 29414 | 2016-10-24 |
| 1295286912 | Mary M Butler | Physical Therapy Assistant | 2230 Ashley Crossing Drive, Charleston, SC 29414 | 2016-10-18 |
| 1295104982 | Charlene Barbot | Registered Nurse | 3741 Clover St, Charleston, SC 29414 | 2015-09-23 |
| 1720467525 | Sasha M. Perez | Family Medicine | 3030 Ashley Town Center Dr Ste 102a, Charleston, SC 29414 | 2015-05-26 |
| 1104226240 | Angela Mcinvale | Counselor | 3030 Ashley Town Center Dr., Bldg. B-203, Charleston, SC 29414 | 2014-08-26 |
| 1659790087 | Catherine Jefferson Vanderwerker | Physical Therapist | 3019 Saintsbury Cove Dr, Charleston, SC 29414 | 2014-04-14 |
| 1104266741 | Elizabeth A Burguieres | Psychiatry & Neurology | Scdmh- Charleston Telepsychiatry Office, 706 Orleans Rd, Charleston, SC 29414 | 2013-06-27 |
| Find all providers in zip 29414 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992262257 | Marnie Rustemeyer | Specialist | 1306 Kanawha Blvd E Ste 1001306, Charleston, WV 25301-3000 | 2019-02-22 |
| 1801307483 | Stacy Phillips | Specialist | 3015 Scuba Dr, Charleston, SC 29414-5696 | 2017-10-23 |
| 1437535705 | Dr Elizabeth Eliza Castle | Specialist | 1527 Sam Rittenberg Blvd Ste 202, Charleston, SC 29407-4189 | 2015-08-10 |
| 1699170084 | Emma Chambers | Specialist | 2059 Wild Flower Ln, Charleston, SC 29414-6471 | 2014-10-28 |
| 1295156404 | Equilibrium Diabetes Center, LLC | Specialist | 1342 Ellison Run, Charleston, SC 29412-8285 | 2013-12-16 |
| 1255689659 | Lindsay Cameron | Specialist | 1804 Huntington Dr, Charleston, SC 29407-3121 | 2012-08-16 |
| 1225304314 | R L Stephens Md Inc | Specialist | 331 Laidley St Ste 204, Charleston, WV 25301-1605 | 2012-03-22 |
| 1720313919 | Norman Frank Kinsey | Specialist | 1 Carriage Ln Ste B201, Charleston, SC 29407-6078 | 2009-10-06 |
| 1952540296 | Kenneth M Stabile | Specialist | 2065 Savannah Hwy, Suite C, Charleston, SC 29407-2225 | 2009-02-10 |
| 1356513550 | Claudia Vivot Welber | Specialist | 217 Calhoun St, Charleston, SC 29401-1313 | 2008-03-27 |
| Find all providers in CHARLESTON | ||||
| City | CHARLESTON |
| Zip Code | 29414 |
Please comment or provide details below to improve the information on CHARLESTON BLOOD DISORDERS & CANCER CENTER, P.A..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.