MEDICARE: ROBERT L ELDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	17991	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154353787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L ELDER M.D.

Provider Business Mailing Address
First Line	:	206 SWIFT CREEK ROAD
Second Line	:
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4383
Country	:	US
Telephone Number	:	843-917-4117
Fax Number	:	843-917-4170

Provider Business Practice Location Address
First Line	:	701 MEDICAL PARK DR
Second Line	:	204
City	:	HARTSVILLE
State	:	SC
Zip	:	29550-4777
Country	:	US
Telephone Number	:	843-383-2273
Fax Number	:	843-383-9476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	06/13/2017

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