| Mdaspect Sc | |
|
913 Bowman Rd Ste 104 Mount Pleasant SC 29464-3235 | |
| (919) 210-6775 | |
| (828) 327-2597 |
| Full Name | Mdaspect Sc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 913 Bowman Rd Ste 104, Mount Pleasant, South Carolina |
| Authorized Official Name and Position | Roy Dickerson (PARTNER) |
| Authorized Official Contact | 9192106775 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mdaspect Sc Po Box 20083 Charlotte NC 28202-0027 Ph: (919) 210-6775 | Mdaspect Sc 913 Bowman Rd Ste 104 Mount Pleasant SC 29464-3235 Ph: (919) 210-6775 |
| NPI Number | 1013550169 |
|---|---|
| Provider Enumeration Date | 10/22/2019 |
| Last Update Date | 10/22/2019 |
| Medicare PECOS PAC ID | 0941636831 |
|---|---|
| Medicare Enrollment ID | O20200213000758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013550169 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Daniel J Uderitz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1295963437 PECOS PAC ID: 1658528815 Enrollment ID: I20120823000718 |
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