Healthcare Provider Details

I. General information

NPI: 1134121015
Provider Name (Legal Business Name): MARIANNE S GERACI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 HOSPITAL DR
CLYDE NC
28721-8026
US

IV. Provider business mailing address

9565 HIGHWAY 78 BLDG 100
LADSON SC
29456-4118
US

V. Phone/Fax

Practice location:
  • Phone: 828-452-5816
  • Fax:
Mailing address:
  • Phone: 843-553-2477
  • Fax: 843-553-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39949
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2018-02527
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: