Provider Demographics
NPI:1639212228
Name:F MARION DWIGHT MD PA
Entity Type:Organization
Organization Name:F MARION DWIGHT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:F
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:DWIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-245-5168
Mailing Address - Street 1:PO BOX 120
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-0120
Mailing Address - Country:US
Mailing Address - Phone:803-245-5168
Mailing Address - Fax:803-245-6275
Practice Address - Street 1:450 NORTH ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1318
Practice Address - Country:US
Practice Address - Phone:803-245-5168
Practice Address - Fax:803-245-6275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC010Medicaid
SC423838Medicare Oscar/Certification