Healthcare Provider Details

I. General information

NPI: 1497719355
Provider Name (Legal Business Name): ANDREW J. MCMARLIN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 HOUSTON NORTHCUTT BLVD STE E
MOUNT PLEASANT SC
29464-3487
US

IV. Provider business mailing address

966 HOUSTON NORTHCUTT BLVD STE E
MOUNT PLEASANT SC
29464-3487
US

V. Phone/Fax

Practice location:
  • Phone: 843-471-0375
  • Fax:
Mailing address:
  • Phone: 843-471-0375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number1530
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1530
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: