Provider Demographics
NPI:1366530735
Name:TOOMER-CLOWNEY, DEIDRE L (MD)
Entity type:Individual
Prefix:MRS
First Name:DEIDRE
Middle Name:L
Last Name:TOOMER-CLOWNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEIDRE
Other - Middle Name:L
Other - Last Name:TOOMER-CLOWNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2719 MIDDLEBURG DR
Mailing Address - Street 2:#204
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-256-1111
Mailing Address - Fax:803-256-2111
Practice Address - Street 1:2719 MIDDLEBURG DR
Practice Address - Street 2:#204
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-256-1111
Practice Address - Fax:803-256-2111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14048207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3490Medicaid
SCE57555Medicare PIN