Healthcare Provider Details

I. General information

NPI: 1154165488
Provider Name (Legal Business Name): ROSS MARNOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 ELLIS OAK DR
CHARLESTON SC
29412-3089
US

IV. Provider business mailing address

169 ASHLEY AVENUIE ROOM 202 MAIN HOSPITAL MSC 333
CHARLESTON SC
29425-0001
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-7080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL92472
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number92472
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: