Provider Demographics
NPI:1225014004
Name:RHAME, ROBERT W JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:RHAME
Suffix:JR
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 1:10 E HOSPITAL STREET
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102
Mailing Address - Country:US
Mailing Address - Phone:803-435-8463
Mailing Address - Fax:
Practice Address - Street 1:10 E HOSPITAL STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-435-8463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9857207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC098575Medicaid
SC40085Medicaid
SC098575Medicaid
SC40085Medicaid
SCB91824Medicare UPIN
SC7946Medicare PIN