Provider Demographics
NPI:1093792426
Name:NETTER, NANCY M (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:NETTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BUENA VISTA WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6621
Mailing Address - Country:US
Mailing Address - Phone:864-990-1825
Mailing Address - Fax:864-284-0856
Practice Address - Street 1:9 BUENA VISTA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6621
Practice Address - Country:US
Practice Address - Phone:864-990-1825
Practice Address - Fax:864-284-0856
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD19398207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC193980Medicaid
SCG592666646Medicare ID - Type Unspecified
SC193980Medicaid