Provider Demographics
NPI:1013203132
Name:DR. PASCALE MARDIKIAN, LLC
Entity Type:Organization
Organization Name:DR. PASCALE MARDIKIAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:PASCALE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARDIKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-377-1600
Mailing Address - Street 1:9263 MEDICAL PLAZA DR STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7112
Mailing Address - Country:US
Mailing Address - Phone:843-377-1600
Mailing Address - Fax:843-377-1601
Practice Address - Street 1:9263 MEDICAL PLAZA DR STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7112
Practice Address - Country:US
Practice Address - Phone:843-377-1600
Practice Address - Fax:843-377-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD297872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty