Provider Demographics
NPI:1154353787
Name:ELDER, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:ELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:206 SWIFT CREEK ROAD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4383
Mailing Address - Country:US
Mailing Address - Phone:843-917-4117
Mailing Address - Fax:843-917-4170
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:204
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4777
Practice Address - Country:US
Practice Address - Phone:843-383-2273
Practice Address - Fax:843-383-9476
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC17991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT19593Medicaid
SCG04723Medicare UPIN