Provider Demographics
NPI:1841256914
Name:WHIDBY, ELMA DENISE (MD)
Entity type:Individual
Prefix:
First Name:ELMA
Middle Name:DENISE
Last Name:WHIDBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2021 N MYRTLE POINT BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2224
Mailing Address - Country:US
Mailing Address - Phone:843-663-2100
Mailing Address - Fax:843-663-2102
Practice Address - Street 1:2021 N MYRTLE POINT BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2224
Practice Address - Country:US
Practice Address - Phone:843-663-2100
Practice Address - Fax:843-663-2102
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC16884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3688Medicaid
SC7612Medicare ID - Type Unspecified
SCGP3688Medicaid