Provider Demographics
NPI:1013321744
Name:MEDICAL UNIVERSITY OF SC
Entity Type:Organization
Organization Name:MEDICAL UNIVERSITY OF SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT PHYSICIAN, DEPT OF PSYCHIA
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:FRYML
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-900-0566
Mailing Address - Street 1:67 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425
Mailing Address - Country:US
Mailing Address - Phone:843-792-0028
Mailing Address - Fax:
Practice Address - Street 1:67 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425
Practice Address - Country:US
Practice Address - Phone:843-792-0028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC371742084P0800X
SCLL37174282N00000X, 283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No282N00000XHospitalsGeneral Acute Care Hospital
No283Q00000XHospitalsPsychiatric HospitalGroup - Single Specialty