Individual
MR. MARK S PRINCIPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
180 WINGO WAY, SUITE 304, MT PLEASANT, SC 29464-1810
(843) 884-8045
(843) 881-5081
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
583
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0431PA
—
SC
01
—
P00930476
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
07/21/2005
Last updated
01/27/2021
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