MEDICARE: MARISA C MAMMARAPPALLIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	2009-01454	NC

General Provider Information

NPI Number	:	1184816746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA C MAMMARAPPALLIL M.D.

Provider Business Mailing Address
First Line	:	4191 MENDENHALL OAKS PKWY
Second Line	:	SUITE 140
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8035
Country	:	US
Telephone Number	:	336-664-6175
Fax Number	:

Provider Business Practice Location Address
First Line	:	4191 MENDENHALL OAKS PKWY
Second Line	:	SUITE 140
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8035
Country	:	US
Telephone Number	:	336-664-6175
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	10/21/2009

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