Provider Demographics
NPI:1629095062
Name:CIANCIOLO, AMY R (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:CIANCIOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:803 N FANT ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5700
Mailing Address - Country:US
Mailing Address - Phone:864-965-9150
Mailing Address - Fax:864-965-9654
Practice Address - Street 1:803 N FANT ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5700
Practice Address - Country:US
Practice Address - Phone:864-965-9150
Practice Address - Fax:864-965-9654
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC20314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203149Medicaid
SC203149Medicaid
SC7098Medicare PIN
SC6608Medicare PIN
SC7043Medicare PIN
SC7025Medicare PIN