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General NPI Number Information
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NPI Number | 1700638889
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Entity Type | Individual
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Provider Name | BETHANY ANN VEGA MD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 81 WILDCAT WAY BLDG 1525
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City | COLUMBIA
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State | SC
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Zip | 29207-6833
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Country | US
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Telephone | 903-751-3820
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Fax |
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Provider Business Mailing Address
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Address Line | 5826 BURT RD APT A
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City | COLUMBIA
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State | SC
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Zip | 29206-6377
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Country | US
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Telephone | 281-790-7984
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0000
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License Number State | WI
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