Healthcare Provider Details

I. General information

NPI: 1720104565
Provider Name (Legal Business Name): MARIAN DEHLINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MARIAN PESECKIS

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411B N. SALEM AVENUE
SUMTER SC
29151
US

IV. Provider business mailing address

215 N. MAGNOLIA ST.
SUMTER SC
29151-4943
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-2103
  • Fax: 803-774-2105
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19935
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: