Provider Demographics
NPI:1619101151
Name:KODER, REGINA ANN
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:ANN
Last Name:KODER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 OLD BRASS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-6535
Mailing Address - Country:US
Mailing Address - Phone:803-427-5403
Mailing Address - Fax:803-438-8626
Practice Address - Street 1:3400 FOREST DR
Practice Address - Street 2:SUITE 2072
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4041
Practice Address - Country:US
Practice Address - Phone:803-427-5403
Practice Address - Fax:803-438-8626
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3428204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM