Provider Demographics
NPI:1952357899
Name:PANOS, CONSTANTINA HELEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CONSTANTINA
Middle Name:HELEN
Last Name:PANOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:DENA
Other - Middle Name:
Other - Last Name:PANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:129 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-2424
Mailing Address - Country:US
Mailing Address - Phone:843-723-1320
Mailing Address - Fax:
Practice Address - Street 1:129 QUEEN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-2424
Practice Address - Country:US
Practice Address - Phone:843-723-1320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA615FP363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
51777Medicare UPIN