Provider Demographics
NPI:1952417800
Name:VANDE STOUWE, ROBERT A (MD PH D)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:VANDE STOUWE
Suffix:
Gender:M
Credentials:MD PH D
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Other - Credentials:
Mailing Address - Street 1:ONE RICHLAND MEDICAL PARK
Mailing Address - Street 2:SUITE 200 CAROLINA ALLERGY AND ASTHMA CONSULTANTS
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-765-9233
Mailing Address - Fax:803-779-0344
Practice Address - Street 1:ONE RICHLAND MEDICAL PARK
Practice Address - Street 2:SUITE 200 CAROLINA ALLERGY AND ASTHMA CONSULTANTS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-765-9233
Practice Address - Fax:803-779-0344
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC11671207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC116715Medicaid
SC116715Medicaid