Provider Demographics
NPI:1457449183
Name:GOULAS, MARK T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:GOULAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:23 PLANTATION PARK DR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6038
Mailing Address - Country:US
Mailing Address - Phone:843-815-5454
Mailing Address - Fax:843-757-9665
Practice Address - Street 1:23 PLANTATION PARK DR STE 401
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6094
Practice Address - Country:US
Practice Address - Phone:843-815-5454
Practice Address - Fax:843-757-9665
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-10-24
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Provider Licenses
StateLicense IDTaxonomies
SCMD26698207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC203414543OtherTAX ID
SC266982Medicaid
SC266982Medicaid
SCI04424Medicare UPIN