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General NPI Number Information
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NPI Number | 1598786188
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Entity Type | Individual
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Provider Name | KATHLEEN L. ANTONETTI MD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 4500 8TH DIVISION RD
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City | COLUMBIA
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State | SC
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Zip | 29207-5700
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Country | US
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Telephone | 803-740-3584
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 SUNSET BLVD ATTN: MANAGED CARE DPT.
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4810
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Country | US
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Telephone | 803-936-7679
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 28241
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License Number State | SC
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