Provider Demographics
NPI:1194774026
Name:SRIBNICK, WAYNE B (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:B
Last Name:SRIBNICK
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 MIDDLEBURG DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2405
Mailing Address - Country:US
Mailing Address - Phone:803-254-2786
Mailing Address - Fax:803-254-9015
Practice Address - Street 1:2701 MIDDLEBURG DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2405
Practice Address - Country:US
Practice Address - Phone:803-254-2786
Practice Address - Fax:803-254-9015
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC112531Medicaid
SC112531Medicaid