Healthcare Provider Details

I. General information

NPI: 1427176544
Provider Name (Legal Business Name): ROLAND RHYSTMAS CRAFT III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR STE 400
WEST COLUMBIA SC
29169-4800
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-3300
  • Fax: 803-936-7735
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number23879
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number23879
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: