Individual
DR. CHARLES JASON ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
225 E WOOD ST, SPARTANBURG, SC 29303-3050
(864) 583-4420
(864) 542-1045
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
853
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
853
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008538
—
SC
05
—
5918608
—
NC
01
—
P00993575
RAILROAD MEDICARE
SC
Enumeration date
07/17/2007
Last updated
12/14/2020
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