Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 8652 | SC |
NPI | 1194761577 |
---|---|
Provider Name | Dr. George Stephen Kotchmar JR. |
First Address | Columbia, SC 29203-8003 |
Second Address | Columbia, SC 29203-6873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 01/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
086524 | (05) | SC |
G75626 | (02) |