MEDICARE: THEODORE W LAW IV 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
1	207Q00000X	Family Medicine Physician	13507	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080013983	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1447203583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE W LAW IV MD

Provider Business Mailing Address
First Line	:	2750 LAUREL ST
Second Line	:	103
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-254-5171
Fax Number	:	803-779-7403

Provider Business Practice Location Address
First Line	:	2750 LAUREL ST
Second Line	:	103
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2038
Country	:	US
Telephone Number	:	803-254-5171
Fax Number	:	803-779-7403

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/12/2010

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Directions to “ THEODORE W LAW IV MD” Practice Location

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