Provider Demographics
NPI:1982625745
Name:EVANGELISTI, PAUL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:EVANGELISTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 N SUMTER ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4916
Mailing Address - Country:US
Mailing Address - Phone:803-778-5970
Mailing Address - Fax:803-778-5403
Practice Address - Street 1:100 N SUMTER ST
Practice Address - Street 2:SUITE 400
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4916
Practice Address - Country:US
Practice Address - Phone:803-778-5970
Practice Address - Fax:803-778-5403
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC22833207Y00000X, 207YS0123X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Not Answered207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Not Answered207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2894Medicaid
SCG29302Medicare UPIN