Provider Demographics
NPI:1952381469
Name:HARGRAVE, RONALD P (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:HARGRAVE
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 1:2701 TYBEE PASS
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7956
Mailing Address - Country:US
Mailing Address - Phone:843-224-3853
Mailing Address - Fax:843-881-3115
Practice Address - Street 1:2701 TYBEE PASS
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7956
Practice Address - Country:US
Practice Address - Phone:843-224-3853
Practice Address - Fax:843-881-3115
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC012316207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC123164Medicaid
SCD17666Medicare UPIN