1710098124 NPI number — ANGELA MARIE SAITO MD

Table of content: ANGELA MARIE SAITO MD (NPI 1710098124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710098124 NPI number — ANGELA MARIE SAITO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAITO
Provider First Name:
ANGELA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710098124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 JOHNNIE DODDS BLVD
Provider Second Line Business Mailing Address:
SUITE 103-175
Provider Business Mailing Address City Name:
MT PLEASANT
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29464-3135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-881-2649
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2683 ELMS PLANTATION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-553-7588
Provider Business Practice Location Address Fax Number:
843-553-8619
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  16738 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16738 . This is a "STATE LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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