Healthcare Provider Details

I. General information

NPI: 1275825994
Provider Name (Legal Business Name): PECORA MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N FANT ST STE 3A
ANDERSON SC
29621-5718
US

IV. Provider business mailing address

PO BOX 357
ANDERSON SC
29622-0357
US

V. Phone/Fax

Practice location:
  • Phone: 864-225-7401
  • Fax: 864-225-7201
Mailing address:
  • Phone: 864-225-7401
  • Fax: 864-225-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA PANAMENO
Title or Position: PRACTICE MANAGER
Credential: MBA
Phone: 864-225-7401