MEDICARE: ELMA DENISE WHIDBY 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	207R00000X	Internal Medicine Physician	16884	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	:	1841256914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELMA DENISE WHIDBY MD

Provider Business Mailing Address
First Line	:	2021 N MYRTLE POINT BLVD
Second Line	:	SUITE 101
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2224
Country	:	US
Telephone Number	:	843-663-2100
Fax Number	:	843-663-2102

Provider Business Practice Location Address
First Line	:	2021 N MYRTLE POINT BLVD
Second Line	:	SUITE 101
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-2224
Country	:	US
Telephone Number	:	843-663-2100
Fax Number	:	843-663-2102

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	02/23/2010

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