MEDICARE: DR. MARIE CELESTE WRIGHT 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	207R00000X	Internal Medicine Physician	9111	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568463610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE CELESTE WRIGHT M.D.

Provider Business Mailing Address
First Line	:	707 PAVILLION AVE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1646
Country	:	US
Telephone Number	:	803-799-5015
Fax Number	:	803-799-5098

Provider Business Practice Location Address
First Line	:	707 PAVILLION AVE
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29205-1646
Country	:	US
Telephone Number	:	803-799-5015
Fax Number	:	803-799-5098

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	10/25/2007

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