Provider Demographics
NPI:1366414997
Name:PARKER, IRENE TALLEY (MD)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:TALLEY
Last Name:PARKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ROCHESTER HWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672-2466
Mailing Address - Country:US
Mailing Address - Phone:864-886-0080
Mailing Address - Fax:
Practice Address - Street 1:501 ROCHESTER HWY
Practice Address - Street 2:SUITE D
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-2466
Practice Address - Country:US
Practice Address - Phone:864-886-0080
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22270207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC222707Medicaid
SCE93103Medicare UPIN