Provider Demographics
NPI:1114126372
Name:DR ARIAS LLC
Entity Type:Organization
Organization Name:DR ARIAS LLC
Other - Org Name:CONSULTORIO MEDICO LATINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-553-7744
Mailing Address - Street 1:2810 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:SUITE B4
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418
Mailing Address - Country:US
Mailing Address - Phone:843-553-7744
Mailing Address - Fax:843-553-7734
Practice Address - Street 1:2810 ASHLEY PHOSPHATE RD
Practice Address - Street 2:SUITE B4
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418
Practice Address - Country:US
Practice Address - Phone:843-553-7744
Practice Address - Fax:843-553-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22122207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4928Medicaid
SCH317528785/8785Medicare PIN