1396008090 NPI number — MARY KATHRYN CONE M.D.

Table of content: MARY KATHRYN CONE M.D. (NPI 1396008090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396008090 NPI number — MARY KATHRYN CONE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONE
Provider First Name:
MARY
Provider Middle Name:
KATHRYN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEANE
Provider Other First Name:
MARY
Provider Other Middle Name:
KATHRYN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD..
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396008090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 RICHLAND MEDICAL PARK DR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29203-6877
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-434-7945
Provider Business Mailing Address Fax Number:
803-434-4100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PEDS DEPT - 14 MEDICAL PARK
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-434-6155
Provider Business Practice Location Address Fax Number:
803-434-6979
Provider Enumeration Date:
06/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  34835 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 348350 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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