Provider Demographics
NPI:1851305031
Name:PAXTOR, CARLOS G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:G
Last Name:PAXTOR
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 1:225 HERLONG AVE S STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2168
Mailing Address - Country:US
Mailing Address - Phone:803-327-9999
Mailing Address - Fax:803-327-9998
Practice Address - Street 1:225 HERLONG AVE S STE 201
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2168
Practice Address - Country:US
Practice Address - Phone:803-327-9999
Practice Address - Fax:803-327-9998
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL29124OtherSTATE LICENSE
SCTL29124OtherSTATE LICENSE