Provider Demographics
NPI:1659399566
Name:AQUINO, LUANN (MD)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:AQUINO
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 OKATIE CENTER BLVD S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7506
Mailing Address - Country:US
Mailing Address - Phone:843-836-3800
Mailing Address - Fax:843-837-7428
Practice Address - Street 1:14 OKATIE CENTER BLVD S
Practice Address - Street 2:SUITE 101
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7506
Practice Address - Country:US
Practice Address - Phone:843-836-3800
Practice Address - Fax:843-837-7428
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045035207R00000X
SC021580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215805Medicaid
GA10063403OtherAMERIGROUP
GAP00121486OtherRR MEDICARE
GA349710OtherWELLCARE
GA000845633CMedicaid
GAP00121486OtherRR MEDICARE
SC215805Medicaid
GA349710OtherWELLCARE
H03805Medicare UPIN