Mario S Bangco, MD

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

17095 Issued in SC

Practice address

8024 Myrtle Trace Dr
Conway, SC 29526-8945

Phone

(843) 234-8950

Fax

(843) 234-8951

NPI assigned

Mar 15, 2006

Last updated

Mar 19, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584576000000",
    "number": "1447229141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SINGLETON RIDGE RD",
            "address_2": "ATTENTION PATIENT ACCOUNTING",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295269142",
            "telephone_number": "843-234-6827",
            "fax_number": "843-234-6990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8024 MYRTLE TRACE DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268945",
            "telephone_number": "843-234-8950",
            "fax_number": "843-234-8951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGCO",
        "first_name": "MARIO",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": "17095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130013055",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL",
            "identifier": "7906457",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170950",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Baldassarri, PA-C
• Stephanie Jayne Ball, LMSW
• Sudeepthi Bandikatla, MD
• Maria Veronica Bandres Urbina, M.D
• Hyun Joon Bang, DO
• Robin Leah Bardill
• Jamie Lee Barkdull
• Nancy A Barker
• Leslie Ethridge Barnes, RN
• Barnett Medical, Inc

• 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 Mar 19, 2020; 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.