DERMATOLOGY AND LASER CENTER OF CHARLESTON/PALMETTO STATE PHARM


Address: 2093 Henry Tecklenburg Dr, Suite 300, Charleston, SC 29414-5741
Phone: 8435568886

DERMATOLOGY AND LASER CENTER OF CHARLESTON/PALMETTO STATE PHARM (NPI# 1508189838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1508189838
Entity Type Organization
Organization Name DERMATOLOGY AND LASER CENTER OF CHARLESTON/PALMETTO STATE PHARM
Other Organization Name PRIMARY RX
Practice Address 2093 Henry Tecklenburg Dr
Suite 300
Charleston
SC 29414-5741
Mailing Address 2000 Sam Rittenberg Blvd
Suite 3009
Charleston
SC 29407-4629
Practice Telephone 8435568886
Practice Fax Number 8883185567
Mailing Telephone 8437697633
Mailing Fax Number 8883185567
Enumeration Date 2010-03-01
Last Update Date 2010-03-03
Authorized Official Name JENNIFER KNAPP (CREDENTIALING SPECIALIST)
Authorized Official Telephone 8434084171
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207N00000X Dermatology 19977 SC Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
SC MEDICARE TYPE UNSPECIFIED 8276 01

Other Provider/Organization Names

Other Name Type Code
Primary Rx Doing Business As Name - Organization

Office Location

Street Address 2093 HENRY TECKLENBURG DR
SUITE 300
City CHARLESTON
State SC
Zip Code 29414-5741

Providers in the same location

NPI Name Taxonomy Address Enumeration
1184628935 Kathryn Manning Hargrove Obstetrics & Gynecology 2093 Henry Tecklenburg Dr, Ste 207, Charleston, SC 29414-5741 2005-06-09
1760934087 Alexander L Miller Physician Assistant 2093 Henry Tecklenburg Dr, Suite 200, Charleston, SC 29414-5741 2016-11-03
1427448273 Sawyer Ann Langston Physician Assistant 2093 Henry Tecklenburg Dr, Suite 200, Charleston, SC 29414-5741 2015-02-02
1952706475 Terri Southard Counselor 2093 Henry Tecklenburg Dr, Suite 202 East, Charleston, SC 29414-5741 2014-10-27
1134538986 Roper Saint Francis Physicians Network Internal Medicine 2093 Henry Tecklenburg Dr, Suite 300e, Charleston, SC 29414 2014-08-06
1871923524 Jessica Elizabeth Raux Physician Assistant 2093 Henry Tecklenburg Dr, Ste. 202e, Charleston, SC 29414-5741 2013-11-16
1891047205 Roper Saint Francis Physicians Network Orthopaedic Surgery 2093 Henry Tecklenburg Dr, Suite 200, Charleston, SC 29414-5741 2012-10-09
1730457250 Callie Rowland Powell Registered Nurse 2093 Henry Tecklenburg Dr, Suite 300, Charleston, SC 29414-5741 2011-12-12
1356620397 Roper Saint Franics Physicians Network Internal Medicine 2093 Henry Tecklenburg Dr, Suite 202 East, Charleston, SC 29414-5741 2011-08-09
1245540277 Roper Saint Francis Physicians Network Surgery 2093 Henry Tecklenburg Dr, Suite 202e, Charleston, SC 29414 2010-10-08
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207N00000X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology

Taxonomy Definition

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1700272978 Leah Swanson Dermatology 135 Rutledge Ave # Msc578, Charleston, SC 29425-8903 2015-04-14
1770996621 David Mark Perry Dermatology 48 Folly Road Blvd, Charleston, SC 29407-7507 2014-06-09
1891106811 Sarah M. Derrington Dermatology 9217 University Blvd., Ste C1b, Charleston, SC 29406 2014-05-13
1649619404 Richard Pierce Dermatology 776 Daniel Ellis Dr Ste 1a, Charleston, SC 29412-3095 2013-06-14
1528096831 Brian Curtis Leach Dermatology 135 Rutledge Avenue, Dept of Dermatology & Dermatologic Surgery, Charleston, SC 29425 2006-06-28
1588629166 Stephen Kirby Milroy Dermatology 3100 Mccorkle Ave Se, Ste 809, Charleston, WV 25304-1223 2006-04-18
1255393484 James G Simpson Dermatology 48 Folly Road, Charleston, SC 29407 2006-04-04
1396713780 Jeffrey K Mckenna Dermatology 100 Deerpath, Charleston, IL 61920-9427 2006-03-10
1689648123 Erin Alyson Walker Dermatology 1364 Ashley River Rd, Charleston, SC 29407-5347 2006-02-13
1003893868 Hudson C Rogers Dermatology 9295 Medical Plaza Dr, Suite B, Charleston, SC 29406-9137 2005-12-22
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Competitor

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City CHARLESTON
Zip Code 29414

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Dataset Information

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.

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