Provider Demographics
NPI:1518189760
Name:CLAIRE J HYDE MD PA
Entity Type:Organization
Organization Name:CLAIRE J HYDE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAIRE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-791-1485
Mailing Address - Street 1:1904 SUNSET BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-5932
Mailing Address - Country:US
Mailing Address - Phone:803-791-1485
Mailing Address - Fax:803-939-9378
Practice Address - Street 1:1904 SUNSET BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-5932
Practice Address - Country:US
Practice Address - Phone:803-791-1485
Practice Address - Fax:803-939-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC221052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4226Medicaid
SCH315408297Medicare ID - Type UnspecifiedMEDICARE NUMBER
SCGP4226Medicaid