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General NPI Number Information
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NPI Number | 1396897286
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC AND INTERVENTIONAL CARDIOLOGY ASSOCIATES, P.A
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2753 LAUREL ST SUITE 2
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City | COLUMBIA
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State | SC
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Zip | 29204-2021
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Country | US
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Telephone | 803-252-1076
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Fax | 803-779-6339
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Provider Business Mailing Address
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Address Line | 2753 LAUREL ST SUITE 2
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City | COLUMBIA
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State | SC
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Zip | 29204-2021
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Country | US
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Telephone | 803-252-1076
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Fax | 803-779-6339
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Authorized Official
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Title or Position | CEO MEDICAL DOCTOR
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Name | DR. MELVYN VANROY MAHON
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Credential | MD FACC
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Telephone | 803-252-1076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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