Provider Demographics
NPI:1740507581
Name:RAWDAN, KATHRYN BETH (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BETH
Last Name:RAWDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 FOREST LN STE D
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29631-2621
Mailing Address - Country:US
Mailing Address - Phone:518-522-2669
Mailing Address - Fax:
Practice Address - Street 1:501 FOREST LN STE D
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-2621
Practice Address - Country:US
Practice Address - Phone:864-722-0369
Practice Address - Fax:864-722-0370
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38705207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCA681OtherMEDICARE
SC387058Medicaid