Healthcare Provider Details

I. General information

NPI: 1447655576
Provider Name (Legal Business Name): AGENOR PAULINO DIAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425
US

IV. Provider business mailing address

169 ASHLEY AVE
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-3072
  • Fax:
Mailing address:
  • Phone: 843-792-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.154486
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: