MEDICARE: DR. PEGGY C WADMAN 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
1	173000000X	Legal Medicine	20443	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	:	1962591784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEGGY C WADMAN M.D.

Provider Business Mailing Address
First Line	:	2026 MAIN ST
Second Line	:
City	:	NEWBERRY
State	:	SC
Zip	:	29108-3522
Country	:	US
Telephone Number	:	803-318-0313
Fax Number	:

Provider Business Practice Location Address
First Line	:	7901 FARROW RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-3220
Country	:	US
Telephone Number	:	803-935-5809
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/08/2008

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