Provider Demographics
NPI:1508287509
Name:BRYAN AND SANG MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:BRYAN AND SANG MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-648-0874
Mailing Address - Street 1:209 ABBEVILLE AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801
Mailing Address - Country:US
Mailing Address - Phone:803-648-0874
Mailing Address - Fax:803-648-5665
Practice Address - Street 1:209 ABBEVILLE AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3923
Practice Address - Country:US
Practice Address - Phone:803-648-0874
Practice Address - Fax:803-648-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12145261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1649357781Medicaid