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NPI Code Detail

MEDICARE: DR. DAVID MACY VIDRINE M.D.

MEDICARE: DR. DAVID MACY VIDRINE 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
1207YP0228XPediatric Otolaryngology Physician226983MA
2207YP0228XPediatric Otolaryngology Physician30117SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2DE5192OTHERSCUNSPECIFIED

General Provider Information

NPI Number : 1447293121
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID MACY VIDRINE M.D.
Provider Business Mailing Address
First Line : PO BOX 520
Second Line :
City : LUGOFF
State : SC
Zip : 29078-0520
Country : US
Telephone Number : 803-408-3277
Fax Number : 803-408-3282
Provider Business Practice Location Address
First Line : 15 EXCHANGE DR
Second Line :
City : LUGOFF
State : SC
Zip : 29078-9198
Country : US
Telephone Number : 803-408-3277
Fax Number : 803-408-3282
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 05/26/2020

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