Provider Demographics
NPI:1275534307
Name:BIONDILLO, DOLI ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:DOLI
Middle Name:ELIZABETH
Last Name:BIONDILLO
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7042
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:3617 CASEY ST
Practice Address - Street 2:SUITE C
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2981
Practice Address - Country:US
Practice Address - Phone:843-716-7911
Practice Address - Fax:843-716-7918
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36148207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5751014OtherAETNA
SC2050741OtherCIGNA
SC30155455OtherSELECT HEALTH
SCSC14298552OtherMEDICARE PTAN
SCP01218899OtherRAILROAD MEDICARE
SC267902OtherMEDCOST
SC361487Medicaid