Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 22833 | SC |
N | 207YS0123X | Facial Plastic Surgeon | 22833 | SC |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 22833 | SC |
NPI | 1982625745 |
---|---|
Provider Name | Paul Andrew Evangelisti |
First Address | Sumter, SC 29150-4916 |
Second Address | Sumter, SC 29150-4916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G29302 | (02) | SC |
GP2894 | (05) | SC |