Healthcare Provider Details

I. General information

NPI: 1427278928
Provider Name (Legal Business Name): ORIN CARLETON GILBERT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONCRIEF ARMY COMMUNITY HOSPITAL IMBODEN ST
FT JACKSON SC
29207
US

IV. Provider business mailing address

4500 STUART AVE. MONCRIEF ARMY COMMUNITY HOSPITAL
COLUMBIA SC
29207
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6789
  • Fax:
Mailing address:
  • Phone: 803-394-0624
  • Fax: 803-299-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: