Mario S. Bangco, MD, PA

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

17095 Issued in SC

Legal business name

MARIO S. BANGCO, MD, PA

Practice address

170 Waccamaw Medical Park CT
Conway, SC 29526-8965

Phone

(843) 347-4473

Fax

(843) 347-0290

NPI assigned

Dec 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mario S Bangco, MD

Title

President

Phone

(843) 347-4473

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317686400000",
    "number": "1093876435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 WACCAMAW MEDICAL PARK CT",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268965",
            "telephone_number": "843-347-4473",
            "fax_number": "843-347-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 WACCAMAW MEDICAL PARK CT",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268965",
            "telephone_number": "843-347-4473",
            "fax_number": "843-347-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO S. BANGCO, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2011-10-04",
        "status": "A",
        "authorized_official_last_name": "BANGCO",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "843-347-4473",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": "17095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF8711",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MCAID GROUP #",
            "identifier": "890195R",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4131",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meghan Lynne Malone, M.D
• Kristie Manjarrez, RN
• Jane Mansfield, REGISTERED NURSE
• Eric Marty Mapula
• Nicholas Darrow Marchase, M.D.
• Robert Michael Marrero Jr., CRNA
• Dorotheal C Marsh
• Susan Martinez, RN
• Andressa Oliveira Martins, ATC
• Michael J Maser, DMD

• Neurology Physician in Conway, SC
• Providers in Conway, SC by specialty
• Neurology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.