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NPI Code Detail

MEDICARE: DR. BRADLEY RAYMOND PENDER MD

MEDICARE: DR. BRADLEY RAYMOND PENDER MD
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
1207L00000XAnesthesiology PhysicianL1428TX

General Provider Information

NPI Number : 1225029119
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY RAYMOND PENDER MD
Provider Business Mailing Address
First Line : 218 AIKEN HUNT CIR
Second Line :
City : COLUMBIA
State : SC
Zip : 29223-8405
Country : US
Telephone Number : 210-602-9051
Fax Number :
Provider Business Practice Location Address
First Line : 6439 GARNERS FERRY RD
Second Line :
City : COLUMBIA
State : SC
Zip : 29209-1638
Country : US
Telephone Number : 803-776-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 02/22/2017

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