Provider Demographics
NPI:1295794386
Name:COBBS, GWENDOLYN PATTERSON (MD)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:PATTERSON
Last Name:COBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5046 HIGHWAY 17 BYP S STE 202
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4503
Mailing Address - Country:US
Mailing Address - Phone:843-293-0466
Mailing Address - Fax:843-293-0534
Practice Address - Street 1:5046 HIGHWAY 17 BYP S STE 202
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4503
Practice Address - Country:US
Practice Address - Phone:843-293-0466
Practice Address - Fax:843-293-0534
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101054118207V00000X
SC84806207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10894Medicare UPIN
VA666296ZAEMedicare PIN
VA00K80W50Medicare ID - Type Unspecified