Provider Demographics
NPI:1861428997
Name:ORTHOPAEDIC ASSOCIATES OF CHARLESTON, PA
Entity type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF CHARLESTON, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-723-9456
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:SUITE 385
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-5736
Mailing Address - Country:US
Mailing Address - Phone:843-723-9456
Mailing Address - Fax:843-577-4506
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:SUITE 385
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5736
Practice Address - Country:US
Practice Address - Phone:843-723-9456
Practice Address - Fax:843-577-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5233207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty