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General NPI Number Information
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NPI Number | 1669738597
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Entity Type | Individual
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Provider Name | MARISSA ANNE MAYOR MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 30 COURTENAY DRIVE MSC 613
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City | CHARLESTON
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State | SC
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Zip | 29425-3821
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Country | US
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Telephone | 843-792-1414
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 751461
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City | CHARLOTTE
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State | NC
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Zip | 28275-1461
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Country | US
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Telephone | 843-792-1414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | MMD.94651
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MMD.94651
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License Number State | SC
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