Provider Demographics
NPI:1922442458
Name:MOYA KRUMENACKER, CATHERINE ANDREA (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:ANDREA
Last Name:MOYA KRUMENACKER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 OAK ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3086
Mailing Address - Country:US
Mailing Address - Phone:843-488-6034
Mailing Address - Fax:
Practice Address - Street 1:1608 MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3572
Practice Address - Country:US
Practice Address - Phone:843-248-4700
Practice Address - Fax:877-322-0181
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076704A207Q00000X
SC89609207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201176810Medicaid
IN201176810Medicaid
IN068010300Medicare PIN