South Charlotte Plastic Surgery, LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

Legal business name

SOUTH CHARLOTTE PLASTIC SURGERY, LLC

Practice address

1721 Ebenezer Rd Ste 115
Rock Hill, SC 29732-1119

Phone

(843) 898-8058

Fax

(843) 405-7021

NPI assigned

May 15, 2019

Organization subpart

No

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

Authorized official

Name

Paul Diegidio, MD

Title

Owner

Phone

(843) 898-8058

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1982260980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 EBENEZER RD STE 115",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321119",
            "telephone_number": "843-898-8058",
            "fax_number": "843-405-7021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 EBENEZER RD STE 115",
            "city": "ROCK HILL",
            "state": "SC",
            "postal_code": "297321119",
            "telephone_number": "843-898-8058",
            "fax_number": "843-405-7021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "802 Green Valley Rd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274087099",
            "country_code": "US",
            "telephone_number": "843-898-8058",
            "fax_number": "843-405-7021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9336 Blakeney Centre Dr Ste 130",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282776667",
            "country_code": "US",
            "telephone_number": "843-898-8058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTH CHARLOTTE PLASTIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-15",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "DIEGIDIO",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-898-8058",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Plastic and Reconstructive Surgery Physician in Rock Hill, SC
• Providers in Rock Hill, SC by specialty
• Plastic and Reconstructive Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 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.