Provider Demographics
NPI:1568446326
Name:CONGDON, GERALD FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:FRANCIS
Last Name:CONGDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-6522
Mailing Address - Country:US
Mailing Address - Phone:888-467-1117
Mailing Address - Fax:888-990-3903
Practice Address - Street 1:201 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-6522
Practice Address - Country:US
Practice Address - Phone:888-467-1117
Practice Address - Fax:888-990-3903
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC197218Medicaid
SC19721Medicaid
SCG78187Medicare UPIN
SC0281Medicare PIN