Healthcare Provider Details

I. General information

NPI: 1932514858
Provider Name (Legal Business Name): MARK LIWANAG DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HOSPITAL CENTER BLVD STE 150
HILTON HEAD ISLAND SC
29926-8701
US

IV. Provider business mailing address

75 BAYLOR DR STE 155
BLUFFTON SC
29910-8965
US

V. Phone/Fax

Practice location:
  • Phone: 854-235-2730
  • Fax:
Mailing address:
  • Phone: 843-682-7480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number95481
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101021270
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number009640
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: