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NPI Code Detail

MEDICARE: PALMETTO DERMATOLOGY

MEDICARE: PALMETTO DERMATOLOGY
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
1207N00000XDermatology Physician

Other Identifiers

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

General Provider Information

NPI Number : 1457433278
Entity Type Code : Organization
Provider Name (Legal Business Name) : PALMETTO DERMATOLOGY
Provider Business Mailing Address
First Line : 3574 SUNSET BLVD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-3044
Country : US
Telephone Number : 803-796-2500
Fax Number : 803-796-4378
Provider Business Practice Location Address
First Line : 3574 SUNSET BLVD
Second Line :
City : WEST COLUMBIA
State : SC
Zip : 29169-3044
Country : US
Telephone Number : 803-796-2500
Fax Number : 803-796-4378
Authorized Official
Title or Position : BILLING COORDINATOR
Name : MRS. TERESA M FLEMING
Credential :
Telephone Number : 803-796-2500
Provider Enumeration Date : 10/20/2006
Last Update Date : 01/17/2012

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1477521136 — DR. KATHERINE C THOMPSON M.D.
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1952379471 — VICKI S ROBERTS P.A.-C
Practice Location Address:
3574 SUNSET BLVD
WEST COLUMBIA, SC
29169-3044
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Practice Fax: 803-796-4378
1821119660 — DR. JEFFREY K SMITH M.D.
Practice Location Address:
3574 SUNSET BLVD
WEST COLUMBIA, SC
29169-3044
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Practice Fax: 803-796-4378
1285979435 — MRS. KENNAH JOHNSON BREARLEY PA-C
Practice Location Address:
3574 SUNSET BLVD
WEST COLUMBIA, SC
29169-3044
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Practice Fax:
1831520782 — BENJAMIN ADDY PA-C
Practice Location Address:
3574 SUNSET BLVD
WEST COLUMBIA, SC
29169-3044
Practice Phone: 803-796-2500
Practice Fax: 803-796-4378

Directions to “PALMETTO DERMATOLOGY ” Practice Location

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