Provider Demographics
NPI:1255378964
Name:CHARLESTON HEMATOLOGY PA
Entity type:Organization
Organization Name:CHARLESTON HEMATOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DAX
Authorized Official - Last Name:ARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:843-577-6957
Mailing Address - Street 1:125 DOUGHTY ST
Mailing Address - Street 2:#280
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403
Mailing Address - Country:US
Mailing Address - Phone:843-577-6957
Mailing Address - Fax:843-577-6523
Practice Address - Street 1:125 DOUGHTY ST
Practice Address - Street 2:#280
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403
Practice Address - Country:US
Practice Address - Phone:843-577-6957
Practice Address - Fax:843-577-6523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1294430001Medicare NSC