Provider Demographics
NPI:1598715518
Name:MEDICAL ASSOCIATES OF ANDERSON,PC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF ANDERSON,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIALDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-716-2647
Mailing Address - Street 1:1 SPRING BACK WAY
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2676
Mailing Address - Country:US
Mailing Address - Phone:864-716-2647
Mailing Address - Fax:864-332-8269
Practice Address - Street 1:1 SPRING BACK WAY
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2676
Practice Address - Country:US
Practice Address - Phone:864-716-2647
Practice Address - Fax:864-332-8269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4342Medicaid
SCGP4342Medicaid