Provider Demographics
NPI:1447749130
Name:RASBERRY, KEVIN ANTHONY (SDVOSB)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANTHONY
Last Name:RASBERRY
Suffix:
Gender:M
Credentials:SDVOSB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 MARSH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7025
Mailing Address - Country:US
Mailing Address - Phone:803-414-7017
Mailing Address - Fax:843-806-3479
Practice Address - Street 1:482 MARSH POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7025
Practice Address - Country:US
Practice Address - Phone:803-414-7017
Practice Address - Fax:843-806-3479
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies