Provider Demographics
NPI:1114177847
Name:PAPPA, CHRYSOULA (MD)
Entity Type:Individual
Prefix:
First Name:CHRYSOULA
Middle Name:
Last Name:PAPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 FARMFIELD AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7757
Mailing Address - Country:US
Mailing Address - Phone:843-571-6067
Mailing Address - Fax:843-769-4853
Practice Address - Street 1:14 FARMFIELD AVE STE E
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7757
Practice Address - Country:US
Practice Address - Phone:843-571-6067
Practice Address - Fax:843-769-4853
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39313207RR0500X
NY62301390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC393130Medicaid
SC1437217718OtherBCBS OF SC
FL0011458-00Medicaid
FL0011458-00Medicaid
GA677023633AMedicaid