Organization
BEACH ANESTHESIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH A. MAGGIONCALDA MD (PRESIDENT)
(843) 692-1062
Entity
Organization
Contact information
Practice address
1021 MEDICAL CIRCLE, SUITE 100, MYRTLE BEACH, SC 29572
(843) 692-1062
Mailing address
PO BOX 7276, COLUMBIA, SC 29202
(803) 765-1838
(803) 765-1732
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4651
—
SC
Enumeration date
03/16/2007
Last updated
10/04/2007
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