Provider Demographics
NPI:1124061445
Name:SCHRIVER, PETER CLARK (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:CLARK
Last Name:SCHRIVER
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 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-897-8280
Mailing Address - Fax:864-897-8281
Practice Address - Street 1:123 WG ACKER DR
Practice Address - Street 2:SUITE D
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2739
Practice Address - Country:US
Practice Address - Phone:864-898-1360
Practice Address - Fax:864-898-1037
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17153208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4587Medicaid
SCF821065664Medicare UPIN
5664Medicare PIN
SCGP4587Medicaid