Provider Demographics
NPI:1972786846
Name:PALMETTO GASTROENTEROLOGY & HEPATOLOGY, PA
Entity Type:Organization
Organization Name:PALMETTO GASTROENTEROLOGY & HEPATOLOGY, PA
Other - Org Name:PALMETTO INTERNAL MEDICINE AND SUB SPECIALTY ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:WARAICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-226-0799
Mailing Address - Street 1:103 GREGG AVE NW
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3096
Mailing Address - Country:US
Mailing Address - Phone:803-226-0799
Mailing Address - Fax:803-563-8614
Practice Address - Street 1:103 GREGG AVE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3096
Practice Address - Country:US
Practice Address - Phone:803-226-0799
Practice Address - Fax:803-563-8614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1751Medicaid
SC5394Medicare PIN
SCF54482Medicare UPIN