Provider Demographics
NPI:1962591784
Name:WADMAN, PEGGY C (MD)
Entity type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:C
Last Name:WADMAN
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 1:2026 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-3522
Mailing Address - Country:US
Mailing Address - Phone:803-318-0313
Mailing Address - Fax:
Practice Address - Street 1:7901 FARROW RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3220
Practice Address - Country:US
Practice Address - Phone:803-935-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20443173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC204433Medicaid
SCH37745Medicare UPIN
SC204433Medicaid