Healthcare Provider Details

I. General information

NPI: 1649392440
Provider Name (Legal Business Name): MS. PASCHA E TROGDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S MAIN ST
DARLINGTON SC
29532-3953
US

IV. Provider business mailing address

424 S MCQUEEN ST
FLORENCE SC
29501-5118
US

V. Phone/Fax

Practice location:
  • Phone: 843-395-6020
  • Fax: 843-395-2595
Mailing address:
  • Phone: 843-230-6138
  • Fax: 843-395-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberBM5921386
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: