Provider Demographics
NPI:1205882891
Name:VICTORIA BABUSHKINA, MD, PC
Entity type:Organization
Organization Name:VICTORIA BABUSHKINA, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BABUSHKINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-560-7079
Mailing Address - Street 1:385 SERPENTINE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3018
Mailing Address - Country:US
Mailing Address - Phone:864-560-7079
Mailing Address - Fax:864-560-7082
Practice Address - Street 1:385 SERPENTINE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3018
Practice Address - Country:US
Practice Address - Phone:864-560-7079
Practice Address - Fax:864-560-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3201Medicaid
SCGP3201Medicaid
SCG18993Medicare UPIN