Provider Demographics
NPI:1780971135
Name:DIEGIDIO, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DIEGIDIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1721 EBENEZER RD STE 115
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1119
Mailing Address - Country:US
Mailing Address - Phone:843-898-8058
Mailing Address - Fax:843-405-7021
Practice Address - Street 1:1721 EBENEZER RD STE 115
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1119
Practice Address - Country:US
Practice Address - Phone:843-898-8058
Practice Address - Fax:843-405-7021
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2020-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2014020762086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery