MEDICARE: MARSHA GIRISH

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	1223G0001X	General Practice Dentistry	112611	CA
2	1223G0001X	General Practice Dentistry	1056	SC
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1376231910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA GIRISH

Provider Business Mailing Address
First Line	:	111 E 210TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2401
Country	:	US
Telephone Number	:	718-920-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	3210 LANDMARK DR STE D
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8486
Country	:	US
Telephone Number	:	843-242-0645
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	01/21/2026

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