Provider Demographics
NPI:1336198571
Name:ORANGEBURG MEDICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:ORANGEBURG MEDICAL ASSOCIATES PA
Other - Org Name:E. HARE, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:HARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-539-2040
Mailing Address - Street 1:PO BOX 1185
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1185
Mailing Address - Country:US
Mailing Address - Phone:803-539-2040
Mailing Address - Fax:
Practice Address - Street 1:1291 GLEN GLORIA ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2525
Practice Address - Country:US
Practice Address - Phone:803-539-2040
Practice Address - Fax:803-539-2826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0919Medicaid
SCGP0919Medicaid