Provider Demographics
NPI:1396767398
Name:DOERING, CHARLES JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOHN
Last Name:DOERING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14361 OCEAN HWY UNIT 2B
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-4806
Mailing Address - Country:US
Mailing Address - Phone:843-651-3937
Mailing Address - Fax:843-651-3940
Practice Address - Street 1:14361 OCEAN HWY UNIT 2B
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-4806
Practice Address - Country:US
Practice Address - Phone:843-651-3937
Practice Address - Fax:843-651-3940
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28722207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC287228Medicaid
NC5905954Medicaid
SCP00464717OtherRAILROAD MEDICARE
SCH831536831Medicare PIN
SC287228Medicaid
SCH831537622Medicare PIN