Individual
REBECCA W WIDENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD.
Contact information
Practice address
9 RICHLAND MEDICAL PARK DR STE 210, COLUMBIA, SC 29203-6859
(803) 434-7995
(803) 434-7983
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
29634
AL
208000000X
Pediatrics Physician
34493
SC
208000000X
Pediatrics Physician
41967
KY
2080P0208X
Pediatric Infectious Diseases Physician
Primary
34493
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112097
—
AL
05
—
344933
—
SC
01
—
AA89852389
MEDICARE PTAN
SC
Enumeration date
07/03/2008
Last updated
03/21/2018
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