MEDICARE: DR. PATRICK RYAN MARCELLO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3609	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225185226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK RYAN MARCELLO DMD

Provider Business Mailing Address
First Line	:	103A REGENCY COMMONS DR
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-5210
Country	:	US
Telephone Number	:	864-801-8877
Fax Number	:	864-801-8897

Provider Business Practice Location Address
First Line	:	103A REGENCY COMMONS DR
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-5210
Country	:	US
Telephone Number	:	864-801-8877
Fax Number	:	864-801-8897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/23/2009

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