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Organization

MARIO S. BANGCO, MD, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARIO S BANGCO MD (PRESIDENT)
(843) 347-4473
Entity
Organization

Contact information

Practice address
170 WACCAMAW MEDICAL PARK CT, CONWAY, SC 29526-8965
(843) 347-4473
(843) 347-0290
Mailing address
170 WACCAMAW MEDICAL PARK CT, CONWAY, SC 29526-8965
(843) 347-4473
(843) 347-0290

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
17095
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
890195R
NC MCAID GROUP #
NC
01
DF8711
RAILROAD MEDICARE
SC
05
GP4131
SC
Enumeration date
12/12/2006
Last updated
10/04/2011
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