Basic Information
| Provider Information | |||||||||
| NPI: | 1275534307 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIONDILLO | ||||||||
| FirstName: | DOLI | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777042 | ||||||||
| FaxNumber: | 8437777102 | ||||||||
| Practice Location | |||||||||
| Address1: | 3617 CASEY ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437167911 | ||||||||
| FaxNumber: | 8437167918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 02/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 36148 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 36148 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 5751014 | 01 | SC | AETNA | OTHER | 2050741 | 01 | SC | CIGNA | OTHER | 30155455 | 01 | SC | SELECT HEALTH | OTHER | SC14298552 | 01 | SC | MEDICARE PTAN | OTHER | P01218899 | 01 | SC | RAILROAD MEDICARE | OTHER | 267902 | 01 | SC | MEDCOST | OTHER | 361487 | 05 | SC | MEDICAID |