Basic Information
| Provider Information | |||||||||
| NPI: | 1801231634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIARA | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3617 CASEY ST STE C | ||||||||
| Address2: | |||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295692981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437167911 | ||||||||
| FaxNumber: | 8437167918 | ||||||||
| Practice Location | |||||||||
| Address1: | 3617 CASEY ST STE C | ||||||||
| Address2: | |||||||||
| City: | LORIS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437167911 | ||||||||
| FaxNumber: | 8437167918 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2013 | ||||||||
| LastUpdateDate: | 07/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036140060 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 036140060 | IL | N | Allopathic & Osteopathic Physicians | Hospitalist | 207RP1001X | 82104 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.