Healthcare Provider Details

I. General information

NPI: 1255890513
Provider Name (Legal Business Name): MARJORY HELEN PESEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 INNOVATION DRIVE SUITE 300
GREENVILLE SC
29607
US

IV. Provider business mailing address

2 INNOVATION DRIVE SUITE 300
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-365-0123
  • Fax: 877-249-9524
Mailing address:
  • Phone: 864-365-0123
  • Fax: 877-249-9524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11173
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number88358
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: