Organization
EDISTO REGIONAL MEDICAL CENTER
Active
Other names
Rachael E Gross, DO
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS DANDRIDGE (PRESIDENT)
(803) 395-2200
Entity
Organization
Contact information
Practice address
1727 VILLAGE PARK DR, ORANGEBURG, SC 29118-2475
(803) 531-2722
Mailing address
PO BOX 1442, ORANGEBURG, SC 29116-1442
(803) 395-4499
(803) 395-4480
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4305
—
SC
Enumeration date
06/02/2006
Last updated
08/22/2020
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