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General NPI Number Information
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NPI Number | 1073826624
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Entity Type | Individual
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Provider Name | CARMEN MICHAEL PICCOLO III D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 02/15/2021
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Provider Practice Location Address
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Address Line | 101 S RAVENEL ST SUITE 230
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City | FLORENCE
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State | SC
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Zip | 29506-2618
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Country | US
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Telephone | 843-777-7043
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Fax | 843-777-7041
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Provider Business Mailing Address
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Address Line | PO BOX 3239
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City | FLORENCE
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State | SC
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Zip | 29502-3239
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Country | US
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Telephone | 843-777-7120
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Fax | 843-777-7102
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 37657
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License Number State | SC
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