Provider Demographics
NPI:1689647588
Name:TRIANA, MARK E (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:TRIANA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 N FRASER ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440-6418
Mailing Address - Country:US
Mailing Address - Phone:843-527-1800
Mailing Address - Fax:843-527-6528
Practice Address - Street 1:2185 N FRASER ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440-6418
Practice Address - Country:US
Practice Address - Phone:843-527-1800
Practice Address - Fax:843-527-6528
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0351207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5770Medicaid
SCA420Medicare PIN
SCG29777Medicare UPIN