Provider Demographics
NPI:1699774034
Name:TRIGIANI, JASON KENNETH (PA-C)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:KENNETH
Last Name:TRIGIANI
Suffix:
Gender:M
Credentials:PA-C
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 601495
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1495
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2454
Practice Address - Street 1:730 STONY LANDING RD
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-2904
Practice Address - Country:US
Practice Address - Phone:800-846-7707
Practice Address - Fax:843-899-7885
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA674363AM0700X, 363AS0400X
SC674363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0026PAMedicaid
SCP17887Medicare UPIN
SC20076508OtherSELECT HEALTH DME
SC970022859OtherRRMC
SCP178871701Medicare ID - Type Unspecified
SC0422990001Medicare NSC
SC1326287434OtherMEDICAID DME NPI
SCP17887Medicare UPIN
SC0026PAMedicaid