Provider Demographics
NPI:1225068760
Name:PHILBECK, MARY CATHARINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHARINE
Last Name:PHILBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 935722
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5722
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:509 NORTH ST
Practice Address - Street 2:BAMBERG COUNTY HOSPITAL
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1330
Practice Address - Country:US
Practice Address - Phone:803-245-6707
Practice Address - Fax:803-245-6279
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19013207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC190135Medicaid
SC190135Medicaid
G25311Medicare UPIN
SCG253115742Medicare PIN