Provider Demographics
NPI:1427526086
Name:TROUTMAN, INA RAE (PA-C)
Entity type:Individual
Prefix:
First Name:INA
Middle Name:RAE
Last Name:TROUTMAN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 HIGHWAY 707
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7304
Mailing Address - Country:US
Mailing Address - Phone:843-215-1100
Mailing Address - Fax:843-215-1211
Practice Address - Street 1:7410 HIGHWAY 707
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7304
Practice Address - Country:US
Practice Address - Phone:843-215-1100
Practice Address - Fax:843-215-1211
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3111363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant