Provider Demographics
NPI:1568409456
Name:WINESETT, DOUGLAS E (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:E
Last Name:WINESETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 140
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4566
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:864-797-6195
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE A140
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-5125
Practice Address - Fax:864-454-5131
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC235682080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1620159OtherCIGNA ID
SC370022612OtherRR MEDICARE
SC576007863094OtherBCBS OF SC ID
SC5215654OtherAETNA ID
SCT78911Medicaid
SCG78643Medicare UPIN
SCG786436904Medicare PIN
SC370022612OtherRR MEDICARE