Healthcare Provider Details

I. General information

NPI: 1932180726
Provider Name (Legal Business Name): WILCOTTE COLLINGWOOD RAHMING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MOORING LN
SALEM SC
29676-4018
US

IV. Provider business mailing address

7 MOORING LN
SALEM SC
29676-4018
US

V. Phone/Fax

Practice location:
  • Phone: 864-719-0181
  • Fax:
Mailing address:
  • Phone: 864-719-0181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number32248
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG59852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: