Healthcare Provider Details

I. General information

NPI: 1104032341
Provider Name (Legal Business Name): SARA MARCINO, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARRIAGE LN STE J
CHARLESTON SC
29407-6060
US

IV. Provider business mailing address

1 CARRIAGE LN STE J
CHARLESTON SC
29407-6060
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-5050
  • Fax:
Mailing address:
  • Phone: 843-573-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number23890
License Number StateSC

VIII. Authorized Official

Name: SARA MARCINO
Title or Position: OWNER
Credential: M.D.
Phone: 843-573-5050