Provider Demographics
NPI:1073561304
Name:RAZICK, MANVER (MD)
Entity Type:Individual
Prefix:
First Name:MANVER
Middle Name:
Last Name:RAZICK
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 1:805 PAMPLICO HWY STE A220
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6065
Mailing Address - Country:US
Mailing Address - Phone:843-674-1530
Mailing Address - Fax:843-673-9098
Practice Address - Street 1:805 PAMPLICO HWY STE A220
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6065
Practice Address - Country:US
Practice Address - Phone:843-674-1530
Practice Address - Fax:843-673-9098
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15371207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC153719Medicaid
SC153719Medicaid
SCE504994759Medicare ID - Type Unspecified