Provider Demographics
NPI:1710098124
Name:SAITO, ANGELA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:SAITO
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 1:1000 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 103-175
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3135
Mailing Address - Country:US
Mailing Address - Phone:843-881-2649
Mailing Address - Fax:
Practice Address - Street 1:2683 ELMS PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9165
Practice Address - Country:US
Practice Address - Phone:843-553-7588
Practice Address - Fax:843-553-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16738261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC16738OtherSTATE LICENSE
SCG05171Medicare UPIN