MEDICARE: JASON KENNETH TRIGIANI 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	A674	SC
2	363AS0400X	Surgical Physician Assistant	A674	SC
3	363AS0400X	Surgical Physician Assistant	674	SC

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	:	1699774034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON KENNETH TRIGIANI PA-C

Provider Business Mailing Address
First Line	:	PO BOX 601495
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1495
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2454

Provider Business Practice Location Address
First Line	:	730 STONY LANDING RD
Second Line	:
City	:	MONCKS CORNER
State	:	SC
Zip	:	29461-2904
Country	:	US
Telephone Number	:	800-846-7707
Fax Number	:	843-899-7885

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	11/02/2021

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Directions to “ JASON KENNETH TRIGIANI PA-C” Practice Location

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