MEDICARE: DR. ANN KOPERA PANACCIONE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RG0100X	Gastroenterology Physician	LL92514	SC
3	208M00000X	Hospitalist Physician	LL92514	SC

General Provider Information

NPI Number	:	1902483514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN KOPERA PANACCIONE DO

Provider Business Mailing Address
First Line	:	171 ASHLEY AVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8908
Country	:	US
Telephone Number	:	843-792-1414
Fax Number	:	843-876-4301

Provider Business Practice Location Address
First Line	:	179 ASHLEY AVE RM 202
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-2113
Country	:	US
Telephone Number	:	843-876-4269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2021
Last Update Date	:	04/29/2025

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