Healthcare Provider Details

I. General information

NPI: 1366897639
Provider Name (Legal Business Name): RAYMOND SCOTT FABER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

V. Phone/Fax

Practice location:
  • Phone: 843-520-8405
  • Fax: 843-520-8459
Mailing address:
  • Phone: 843-520-8405
  • Fax: 843-520-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101261834
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101261834
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: