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General NPI Number Information
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NPI Number | 1831150226
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Entity Type | Individual
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Provider Name | ELAINE B BAXLEY MD
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Gender | Female
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 07/12/2024
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Provider Practice Location Address
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Address Line | 643 HIGHWAY 1 S
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City | LUGOFF
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State | SC
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Zip | 29078-9174
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Country | US
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Telephone | 803-243-0988
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Fax |
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Provider Business Mailing Address
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Address Line | 1606 LAKEVIEW AVE
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City | CAMDEN
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State | SC
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Zip | 29020-2929
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Country | US
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Telephone | 803-243-0988
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 12579
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12579
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 12579
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License Number State | SC
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