Provider Demographics
NPI:1629086004
Name:PAPPAS, THEODORE M (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:M
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:1400 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3255
Practice Address - Country:US
Practice Address - Phone:843-884-1341
Practice Address - Fax:843-884-1345
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC15938Medicaid
SCP00982687OtherRAILROAD MEDICARE ID-RSFPN
SCP00982687OtherRAILROAD MEDICARE ID-RSFPN
SCE815537302Medicare ID - Type Unspecified
SCE815539223Medicare PIN