Healthcare Provider Details

I. General information

NPI: 1760645899
Provider Name (Legal Business Name): COLIN ENGLISH WIDENER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 FOREST DR
COLUMBIA SC
29204-2026
US

IV. Provider business mailing address

2435 FEOREST DRIVE
COLUMBIA SC
29204-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-5855
  • Fax: 803-400-5089
Mailing address:
  • Phone: 803-256-5855
  • Fax: 803-400-5089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34433
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD.29527
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34433
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: