Provider Demographics
NPI:1356458061
Name:ALDRICH, WILLIAM C (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:ALDRICH
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 1:1036 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-2827
Mailing Address - Country:US
Mailing Address - Phone:803-433-5220
Mailing Address - Fax:803-433-5221
Practice Address - Street 1:1036 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2827
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:803-746-7445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC139157Medicaid
SC9640181OtherGHI
SCP00360790OtherRAILROAD MEDICARE
SCG5090OtherMDIGOLD
SC20025399OtherSELECT HEALTH FIRST CHOICE
SC20025399OtherSELECT HEALTH FIRST CHOICE
SCP00360790OtherRAILROAD MEDICARE
SC9640181OtherGHI