Provider Demographics
NPI:1336113646
Name:RICALDE, ORLANDO ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:ARTHUR
Last Name:RICALDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBRA ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0831
Mailing Address - Country:US
Mailing Address - Phone:864-885-9866
Mailing Address - Fax:864-888-8307
Practice Address - Street 1:100 DEBRA ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0831
Practice Address - Country:US
Practice Address - Phone:864-885-9866
Practice Address - Fax:864-888-8307
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC184482084N0400X
MS240262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT24898Medicaid
SCG29699Medicare UPIN