Healthcare Provider Details

I. General information

NPI: 1013203132
Provider Name (Legal Business Name): DR. PASCALE MARDIKIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 MEDICAL PLAZA DR STE A
NORTH CHARLESTON SC
29406-7112
US

IV. Provider business mailing address

9263 MEDICAL PLAZA DR STE A
NORTH CHARLESTON SC
29406-7112
US

V. Phone/Fax

Practice location:
  • Phone: 843-377-1600
  • Fax: 843-377-1601
Mailing address:
  • Phone: 843-377-1600
  • Fax: 843-377-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD29787
License Number StateSC

VIII. Authorized Official

Name: PASCALE N MARDIKIAN
Title or Position: PHYSICIAN/PSYCHIATRIST
Credential: MD
Phone: 843-377-1600