Individual
DR. MARIO S BANGCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8024 MYRTLE TRACE DR, CONWAY, SC 29526-8945
(843) 234-8950
(843) 234-8951
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PATIENT ACCOUNTING, CONWAY, SC 29526-9142
(843) 234-6827
(843) 234-6990
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
17095
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130013055
RAILROAD MEDICARE
SC
05
—
170950
—
SC
01
—
7906457
INDIVIDUAL
NC
Enumeration date
03/15/2006
Last updated
03/19/2020
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