Provider Demographics
NPI:1275704959
Name:MONICA LOMINCHAR MD INTERNAL MEDICINE AND PALMETTO WGT MGT INC
Entity Type:Organization
Organization Name:MONICA LOMINCHAR MD INTERNAL MEDICINE AND PALMETTO WGT MGT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOMINCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-554-8488
Mailing Address - Street 1:2079 CHARLIE HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5834
Mailing Address - Country:US
Mailing Address - Phone:843-554-8488
Mailing Address - Fax:843-554-5445
Practice Address - Street 1:2079 CHARLIE HALL BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5834
Practice Address - Country:US
Practice Address - Phone:843-554-8488
Practice Address - Fax:843-554-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3623Medicaid
SC7473Medicare PIN
SCG05879Medicare UPIN