1821293093 NPI number — DR. CONSTANCE LYNNE BELISSARY MARONEY MD

Table of content: DR. CONSTANCE LYNNE BELISSARY MARONEY MD (NPI 1821293093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821293093 NPI number — DR. CONSTANCE LYNNE BELISSARY MARONEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARONEY
Provider First Name:
CONSTANCE LYNNE
Provider Middle Name:
BELISSARY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELISSARY
Provider Other First Name:
CONSTANCE
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821293093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29502-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-777-7341
Provider Business Mailing Address Fax Number:
843-777-7345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 SOUTH RAVENEL STREET
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29506-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-777-7341
Provider Business Practice Location Address Fax Number:
843-777-7345
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  28803 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 0101239343 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 071 . This is a "BCBS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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