Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 36272 | SC |
NPI | 1487857272 |
---|---|
Provider Name | Patrick Constantine Angelos |
First Address | Charleston, SC 29414-7801 |
Second Address | Charleston, SC 29414-7801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 29/08/2014 |