Provider Demographics
NPI:1679544100
Name:PADGETT, EDWIN (MD)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:PADGETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-5935
Mailing Address - Country:US
Mailing Address - Phone:843-777-6870
Mailing Address - Fax:843-777-6886
Practice Address - Street 1:3015 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5935
Practice Address - Country:US
Practice Address - Phone:843-777-6870
Practice Address - Fax:843-777-6886
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19529207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790625TMedicaid
SC080138851OtherRAILROAD MEDICARE
SC195292Medicaid
SC20066218OtherSELECT HEALTH
SC201628OtherMEDCOST
SC20066218OtherSELECT HEALTH
G74262Medicare UPIN
SC080138851OtherRAILROAD MEDICARE
NC790625TMedicaid
SCG742626067Medicare PIN
SCG742629068Medicare PIN