Provider Demographics
NPI:1790746709
Name:PARKER, REGINALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:L
Last Name:PARKER
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 1:115 BLARNEY DR
Mailing Address - Street 2:STE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6291
Mailing Address - Country:US
Mailing Address - Phone:803-419-5131
Mailing Address - Fax:803-419-5129
Practice Address - Street 1:115 BLARNEY DR
Practice Address - Street 2:STE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6291
Practice Address - Country:US
Practice Address - Phone:803-419-5131
Practice Address - Fax:803-419-5129
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14862207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL2517Medicaid
SCB61961Medicare UPIN