Basic Information
| Provider Information | |||||||||
| NPI: | 1194761577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOTCHMAR | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 MEDICAL PARK RD | ||||||||
| Address2: | SUITE 200A | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292038003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034347956 | ||||||||
| FaxNumber: | 8034348606 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 MEDICAL PARK RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034347995 | ||||||||
| FaxNumber: | 8034348606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 12/01/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0208X | 8652 | SC | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 086524 | 05 | SC | MEDICAID |