Provider Demographics
NPI:1104684299
Name:PANGLE, CALEN DAVID (RD)
Entity type:Individual
Prefix:
First Name:CALEN
Middle Name:DAVID
Last Name:PANGLE
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 BELLE ISLE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8379
Mailing Address - Country:US
Mailing Address - Phone:828-342-9683
Mailing Address - Fax:
Practice Address - Street 1:1501 BELLE ISLE AVE STE 110
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8379
Practice Address - Country:US
Practice Address - Phone:828-342-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLRD.1401133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered