Organization
CAROLINA DERMATOLOGY CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD A. KOTZ III MD (OWNER)
(843) 766-9868
Entity
Organization
Contact information
Practice address
933 SAINT ANDREWS BLVD, CHARLESTON, SC 29407
(843) 766-9868
(843) 571-4925
Mailing address
933 SAINT ANDREWS BLVD., CHARLESTON, SC 29407
(843) 766-9868
(843) 571-4925
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
24039
SC
207N00000X
Dermatology Physician
Primary
24039
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240395
—
SC
05
—
GROUPGP4945
—
SC
Enumeration date
03/13/2007
Last updated
01/18/2011
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