Provider Demographics
NPI:1619995065
Name:HASKILL STROWD, REBECCA RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RUTH
Last Name:HASKILL STROWD
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:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29114-0488
Mailing Address - Country:US
Mailing Address - Phone:843-396-4619
Mailing Address - Fax:
Practice Address - Street 1:139 MAIN STREET
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114-0488
Practice Address - Country:US
Practice Address - Phone:843-396-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC181128Medicaid
G18174Medicare UPIN
SC181128Medicaid