Provider Demographics
NPI:1669902011
Name:CABRERA FERMIN, CLARA MIGUELINA (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:MIGUELINA
Last Name:CABRERA FERMIN
Suffix:
Gender:
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:PO BOX 1090
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1090
Mailing Address - Country:US
Mailing Address - Phone:843-857-0111
Mailing Address - Fax:843-309-8126
Practice Address - Street 1:1016 OLD LATTA HWY
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-7614
Practice Address - Country:US
Practice Address - Phone:843-774-4337
Practice Address - Fax:843-774-4373
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC84950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC849504Medicaid