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General NPI Number Information
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NPI Number | 1306780788
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Entity Type | Individual
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Provider Name | MARIO RICHARD NP
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Gender | Male
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 401 CLYDE CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29170-2486
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Country | US
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Telephone | 803-201-7451
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Fax |
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Provider Business Mailing Address
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Address Line | 401 CLYDE CT
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City | WEST COLUMBIA
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State | SC
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Zip | 29170-2486
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Country | US
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Telephone |
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 31570
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License Number State | SC
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