Basic Information
| Provider Information | |||||||||
| NPI: | 1558355958 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAROODY | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1523 HERITAGE LN | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295053197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436739992 | ||||||||
| FaxNumber: | 8436739996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1523 HERITAGE LN | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295053197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436739992 | ||||||||
| FaxNumber: | 8436739996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 01/30/2019 | ||||||||
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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 | 207V00000X | 23624 | SC | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | GP2348 | 05 | SC | MEDICAID |