Basic Information
| Provider Information | |||||||||
| NPI: | 1760645899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIDENER | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | ENGLISH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2435 FEOREST DRIVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292042145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032565855 | ||||||||
| FaxNumber: | 8034005089 | ||||||||
| Practice Location | |||||||||
| Address1: | 2435 FOREST DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292042026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032565855 | ||||||||
| FaxNumber: | 8034005089 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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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 | 208000000X | 34433 | SC | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0203X | MD.29527 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 208M00000X | 34433 | SC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.