Provider Demographics
NPI:1023017993
Name:PRINCIPE, MARK S (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:S
Last Name:PRINCIPE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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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 1:180 WINGO WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-8045
Practice Address - Fax:843-881-5081
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC583363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0431PAMedicaid
SCP00930476OtherRAILROAD MEDICARE ID-RSFPN
SCS929879499Medicare UPIN
SCAA50609223Medicare PIN
SC0431PAMedicaid
SCP00930476OtherRAILROAD MEDICARE ID-RSFPN