Healthcare Provider Details

I. General information

NPI: 1891222824
Provider Name (Legal Business Name): PAULINE DIBIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2017
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 SUNSET BLVD
WEST COLUMBIA SC
29169-4810
US

IV. Provider business mailing address

624 CRESSON LN
MORTON PA
19070-1904
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7372
  • Fax: 803-936-4102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2020-03012
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number89711
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2020-03012
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: