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ANDERSON SKIN AND CANCER CLINIC NPI 1639398480


NPI Information

NPI: 1639398480
Provider Name: ANDERSON SKIN AND CANCER CLINIC

Doing Business As: DERMATOPATHOLOGY CONSULTATION SERVICE

Classification: Dermatology - 207ND0900X
Entity Type: Organization

Specialization: Dermatopathology

CLIA Number: 42D1065155

Address:
2022 CARDINAL CIR
ANDERSON, SC
ZIP 29621
Phone: (864) 224-7577
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ANDERSON SKIN AND CANCER CLINIC is a dermatopathology dermatology in Anderson, SC. The provider is a dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. ANDERSON SKIN AND CANCER CLINIC NPI is 1639398480. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dermatopathology Consultation Service.

The provider's business location address is:

2022 CARDINAL CIR
ANDERSON, SC
ZIP 29621-504
Phone: (864) 224-7577
Fax: (864) 225-5165

The provider's authorized official is Mark Johnson Quarterman .
The authorized official title is President and has the following contact phone number (864) 224-7577.

The CLIA number assigned to this NPI record is 42D1065155 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 4/24/2007 and was last updated on 9/14/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207ND0900XDermatologyDermatopathology16908SOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12961MEDICAIDSOUTH CAROLINA
22329OTHERSOUTH CAROLINAMEDICARE ID
33937PAMEDICAIDSOUTH CAROLINA
4NP2759MEDICAIDSOUTH CAROLINA
5SC98802329OTHERSOUTH CAROLINAMC PTAN
6TL7847MEDICAIDSOUTH CAROLINA
7404271MEDICAIDSOUTH CAROLINA
8AA5766OTHERSOUTH CAROLINAMC UPIN
9PA4496MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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