Provider Demographics
NPI:1194761577
Name:KOTCHMAR, GEORGE STEPHEN JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:STEPHEN
Last Name:KOTCHMAR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8003
Mailing Address - Country:US
Mailing Address - Phone:803-434-7956
Mailing Address - Fax:803-434-8606
Practice Address - Street 1:9 MEDICAL PARK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6873
Practice Address - Country:US
Practice Address - Phone:803-434-7995
Practice Address - Fax:803-434-8606
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC86522080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC086524Medicaid
SCG756262389Medicare PIN
G75626Medicare UPIN
G756262389Medicare ID - Type Unspecified