1013965532 NPI number — MARC JAMES COMIANOS DO

Table of content: DR. CHANCHAL K SAHA M. D. (NPI 1720002595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013965532 NPI number — MARC JAMES COMIANOS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COMIANOS
Provider First Name:
MARC
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1013965532
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29502-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-390-8320
Provider Business Mailing Address Fax Number:
843-390-8329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3980 HIGHWAY 9 E STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE RIVER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29566-8163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-390-8320
Provider Business Practice Location Address Fax Number:
843-390-8329
Provider Enumeration Date:
05/05/2006

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: 207R00000X , with the licence number:  34004891C , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 1431 , 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: 000000118340 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0400998 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0673973 . This is a "PALMETTO MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 353077 . This is a "SUBMITTER NO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 635999 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 014317 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110071156 . This is a "TRAVELERS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 311098079029 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0871730 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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