Provider Demographics
NPI:1912953027
Name:BOATWRIGHT, HARRY WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:WADE
Last Name:BOATWRIGHT
Suffix:
Gender:M
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 81060
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-1060
Mailing Address - Country:US
Mailing Address - Phone:843-571-0200
Mailing Address - Fax:843-763-4173
Practice Address - Street 1:1483 TOBIAS GADSON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4796
Practice Address - Country:US
Practice Address - Phone:843-571-0200
Practice Address - Fax:843-763-4173
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12402207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC124029Medicaid
SCGP1725Medicaid
SCB919170281Medicare PIN
SCGP1725Medicaid