MEDICARE: MR. MARK S PRINCIPE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	583	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00930476	OTHER	SC	RAILROAD MEDICARE ID-RSFPN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023017993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK S PRINCIPE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	180 WINGO WAY
Second Line	:	SUITE 304
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-1810
Country	:	US
Telephone Number	:	843-884-8045
Fax Number	:	843-881-5081

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	01/27/2021

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Directions to “ MR. MARK S PRINCIPE PA-C” Practice Location

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