Provider Demographics
NPI:1447236815
Name:SKINNER, WRIGHT S III (MD)
Entity Type:Individual
Prefix:
First Name:WRIGHT
Middle Name:S
Last Name:SKINNER
Suffix:III
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:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3321
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:402 NELSON BLVD STE 400
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4058
Practice Address - Country:US
Practice Address - Phone:843-355-5363
Practice Address - Fax:843-355-5365
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC103934207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDM0379OtherMEDICAID DMERC
SC200042355OtherRAILROAD PROVIDER NUMBER
SCGP0007Medicaid
SCGP0007Medicaid
SCQ240143673Medicare ID - Type Unspecified
SC0524370001Medicare NSC