Basic Information
| Provider Information | |||||||||
| NPI: | 1568877991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DILLON | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1022 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435730499 | ||||||||
| FaxNumber: | 8435732463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 PHYSICIANS DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435730499 | ||||||||
| FaxNumber: | 8435732463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2014 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD51172 | SC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RN0300X | MD51172 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.