Healthcare Provider Details

I. General information

NPI: 1235119793
Provider Name (Legal Business Name): MARY L KEMICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E MEDICAL LN STE 120
WEST COLUMBIA SC
29169-4817
US

IV. Provider business mailing address

PO BOX 896239
CHARLOTTE NC
28289-6239
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7450
  • Fax:
Mailing address:
  • Phone: 803-936-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number16287
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: