Provider Demographics
NPI:1538144795
Name:HARE, ESTER ROSE (MDPHDFACP)
Entity Type:Individual
Prefix:DR
First Name:ESTER
Middle Name:ROSE
Last Name:HARE
Suffix:
Gender:F
Credentials:MDPHDFACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1291 GLEN GLORIA ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2525
Mailing Address - Country:US
Mailing Address - Phone:803-539-2040
Mailing Address - Fax:803-539-2826
Practice Address - Street 1:1291 GLEN GLORIA ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2525
Practice Address - Country:US
Practice Address - Phone:803-539-2040
Practice Address - Fax:803-539-2826
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9130OtherMEDICARE PTAN
SCGP0919Medicaid
SCF77262Medicare UPIN
SCGP0919Medicaid