Provider Demographics
NPI:1407818065
Name:UMBACH, RICHARD E (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:UMBACH
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 1:2601 LAUREL ST
Mailing Address - Street 2:STE 260
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2033
Mailing Address - Country:US
Mailing Address - Phone:803-744-4900
Mailing Address - Fax:803-744-4983
Practice Address - Street 1:2601 LAUREL ST
Practice Address - Street 2:STE 260
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2033
Practice Address - Country:US
Practice Address - Phone:803-744-4900
Practice Address - Fax:803-744-4983
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC09103207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC91037Medicaid
SC91037Medicaid