Provider Demographics
NPI:1942206362
Name:PADGETT, RONALD DALE (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:DALE
Last Name:PADGETT
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 1:86 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-259-5762
Mailing Address - Fax:803-259-3250
Practice Address - Street 1:526 NORTH STREET
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1319
Practice Address - Country:US
Practice Address - Phone:803-245-2433
Practice Address - Fax:803-245-6274
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2023-09-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
SC10332208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC103328Medicaid
SCSC9829OtherMEDICARE
SC10332OtherMEDICAL LICENSE
SCRHC020Medicaid
SC4173Medicare PIN