MEDICARE: MARIANA CARSON

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1972487510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA CARSON

Provider Business Mailing Address
First Line	:	1428 ASHLEY GARDEN BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-9125
Country	:	US
Telephone Number	:	843-367-9362
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 ASHLEY GARDEN BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-9125
Country	:	US
Telephone Number	:	843-367-9362
Fax Number	:

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

Provider Enumeration Date	:	08/05/2025
Last Update Date	:	09/11/2025

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Directions to “ MARIANA CARSON ” Practice Location

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