Provider Demographics
NPI:1285698746
Name:HINDERSMAN, JOHN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HINDERSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2750 LAUREL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-799-0585
Mailing Address - Fax:803-256-1312
Practice Address - Street 1:2750 LAUREL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-799-0585
Practice Address - Fax:803-256-1312
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7387207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC073878Medicaid
B92379Medicare UPIN
1981Medicare ID - Type Unspecified