Provider Demographics
NPI:1528007093
Name:MCCRAW, RHETT COTESWORTH JR (MD)
Entity Type:Individual
Prefix:
First Name:RHETT
Middle Name:COTESWORTH
Last Name:MCCRAW
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 580
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4247
Practice Address - Country:US
Practice Address - Phone:864-455-7874
Practice Address - Fax:864-455-8933
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11308207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863082OtherBLUE CHOICE OF SC
SCP00014369OtherRR MEDICARE
SC4349832OtherAETNA
SC113086Medicaid
SC5135846OtherCIGNA
SC576007863082OtherBCBS OF SC
SCP00817206OtherRR MEDICARE
SC5135846OtherCIGNA
SC4349832OtherAETNA
SCC67535Medicare UPIN