Healthcare Provider Details

I. General information

NPI: 1639398480
Provider Name (Legal Business Name): ANDERSON SKIN AND CANCER CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 CARDINAL CIR
ANDERSON SC
29621-1504
US

IV. Provider business mailing address

2022 CARDINAL CIR
ANDERSON SC
29621-1504
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-7577
  • Fax: 864-225-5165
Mailing address:
  • Phone: 864-224-7577
  • Fax: 864-225-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number16908
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2961
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier2329
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerMEDICARE ID
# 3
Identifier3937PA
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 4
IdentifierNP2759
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 5
IdentifierSC98802329
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerMC PTAN
# 6
IdentifierTL7847
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 7
Identifier404271
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 8
IdentifierAA5766
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerMC UPIN
# 9
IdentifierPA4496
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name: MARK JOHNSON QUARTERMAN
Title or Position: OWNER
Credential:
Phone: 864-224-7577