Healthcare Provider Details

I. General information

NPI: 1780829465
Provider Name (Legal Business Name): REBECCA SUSAN BISCOGLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 KINARD ST
NEWBERRY SC
29108-2909
US

IV. Provider business mailing address

PO BOX 3788
COLUMBIA SC
29230-3788
US

V. Phone/Fax

Practice location:
  • Phone: 803-405-0220
  • Fax:
Mailing address:
  • Phone: 803-733-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34614
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: