Provider Demographics
NPI:1568432128
Name:THOMAS, RENEE BETHEA (MD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:BETHEA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 CARRIAGE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2752
Mailing Address - Country:US
Mailing Address - Phone:803-424-2304
Mailing Address - Fax:
Practice Address - Street 1:1905 CARRIAGE HOUSE LN
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2752
Practice Address - Country:US
Practice Address - Phone:803-424-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16675207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDD4130OtherRAILROAD MEDICARE GROUP
SCP00226494OtherRAILROAD MEDICARE
SCGP4159OtherMEDICAID GROUP
SC166750Medicaid
SC8256OtherMEDICARE GROUP
SC166750Medicaid
SCG026958256Medicare PIN