Individual
MR. JAMES JOSEPH PAVAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2145 HENRY TECKLENBURG DR, CHARLESTON, SC 29414-5893
(843) 723-8823
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1325
SC
363AS0400X
Surgical Physician Assistant
1582
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0733PA
—
SC
01
—
5551
MEDICARE GROUP #
SC
01
—
GP5004
MEDICAID GROUP #
SC
01
—
GP5005
MEDICAID GROUP #
SC
01
—
GP5006
MEDICAID GROUP #
SC
01
—
GP5007
MEDICAID GROUP #
SC
01
—
GP5072
MEDICAID GROUP #
SC
01
—
P00648630
RAILROAD MEDICARE ID
SC
Enumeration date
10/12/2006
Last updated
10/20/2015
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