Provider Demographics
NPI:1033160254
Name:MCLENDON, BAXTER (MD)
Entity Type:Individual
Prefix:
First Name:BAXTER
Middle Name:
Last Name:MCLENDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:BRUNSON
Mailing Address - State:SC
Mailing Address - Zip Code:29911-0599
Mailing Address - Country:US
Mailing Address - Phone:803-632-1699
Mailing Address - Fax:803-632-2451
Practice Address - Street 1:333 REVOLUTIONARY TRL
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:SC
Practice Address - Zip Code:29827-7109
Practice Address - Country:US
Practice Address - Phone:803-632-2533
Practice Address - Fax:803-632-2451
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6266174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1355Medicaid
SC062666Medicaid
SCGP2629Medicaid
SCC60948Medicare UPIN
SCGP1355Medicaid