Provider Demographics
NPI:1114177847
Name:PAPPA, CHRYSOULA (MD)
Entity type:Individual
Prefix:
First Name:CHRYSOULA
Middle Name:
Last Name:PAPPA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-527-7000
Mailing Address - Fax:
Practice Address - Street 1:4040 HIGHWAY 17 UNIT 301
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5098
Practice Address - Country:US
Practice Address - Phone:843-652-8205
Practice Address - Fax:843-652-8215
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39313207RR0500X
NY62301390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1437217718OtherBCBS OF SC
SC393130Medicaid
FL0011458-00Medicaid
FL0011458-00Medicaid
GA677023633AMedicaid