Provider Demographics
NPI:1205892494
Name:MONITTO, DREW CARL (MD)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:CARL
Last Name:MONITTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 EAST WOOD STREET
Practice Address - Street 2:DEPT OF RADIATION ONCOLOGY
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6917
Practice Address - Fax:864-560-6017
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC199912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89067C2Medicaid
SCSC14307652OtherMEDICARE PIN
SC199911Medicaid
SCP01235997OtherRAILROAD MEDICARE
NC890124VMedicaid
SCP00060061OtherRAILROAD MEDICARE
SCGP0371Medicaid
SCGP0371Medicaid
G82483Medicare UPIN