Healthcare Provider Details

I. General information

NPI: 1194761577
Provider Name (Legal Business Name): GEORGE STEPHEN KOTCHMAR JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 MEDICAL PARK RD SUITE 210
COLUMBIA SC
29203-6873
US

IV. Provider business mailing address

9 MEDICAL PARK RD SUITE 200A
COLUMBIA SC
29203-8003
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7995
  • Fax: 803-434-8606
Mailing address:
  • Phone: 803-434-7956
  • Fax: 803-434-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number8652
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: