Provider Demographics
NPI:1457319535
Name:SY, RAMON PROCTAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:PROCTAN
Last Name:SY
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 1:15 E HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3152
Mailing Address - Country:US
Mailing Address - Phone:803-435-2529
Mailing Address - Fax:803-435-4196
Practice Address - Street 1:15 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-3152
Practice Address - Country:US
Practice Address - Phone:803-435-2529
Practice Address - Fax:803-435-4196
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20345207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203452Medicaid
SC203452Medicaid
SCG78984Medicare UPIN