Healthcare Provider Details

I. General information

NPI: 1013321744
Provider Name (Legal Business Name): MEDICAL UNIVERSITY OF SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425
US

IV. Provider business mailing address

67 PRESIDENT ST
CHARLESTON SC
29425
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0028
  • Fax:
Mailing address:
  • Phone: 843-792-0028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number37174
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberLL37174
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberLL37174
License Number StateSC

VIII. Authorized Official

Name: DR. LEAH DANIELLE FRYML
Title or Position: RESIDENT PHYSICIAN, DEPT OF PSYCHIA
Credential: MD
Phone: 843-900-0566