Healthcare Provider Details

I. General information

NPI: 1699774034
Provider Name (Legal Business Name): JASON KENNETH TRIGIANI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 STONY LANDING RD
MONCKS CORNER SC
29461-2904
US

IV. Provider business mailing address

PO BOX 601495
CHARLOTTE NC
28260-1495
US

V. Phone/Fax

Practice location:
  • Phone: 800-846-7707
  • Fax: 843-899-7885
Mailing address:
  • Phone: 843-789-1620
  • Fax: 843-724-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberA674
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberA674
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number674
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: