Provider Demographics
NPI:1700264603
Name:AIKEN CENTER FOR DERMATOLOGY
Entity type:Organization
Organization Name:AIKEN CENTER FOR DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:CHESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-641-0049
Mailing Address - Street 1:118 PARK AVE SW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3835
Mailing Address - Country:US
Mailing Address - Phone:803-641-0049
Mailing Address - Fax:803-641-0810
Practice Address - Street 1:118 PARK AVE SW
Practice Address - Street 2:SUITE 100
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3835
Practice Address - Country:US
Practice Address - Phone:803-641-0049
Practice Address - Fax:803-641-0810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15803207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF549800281Medicare UPIN