Basic Information
| Provider Information | |||||||||
| NPI: | 1821293093 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARONEY | ||||||||
| FirstName: | CONSTANCE LYNNE | ||||||||
| MiddleName: | BELISSARY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BELISSARY | ||||||||
| OtherFirstName: | CONSTANCE | ||||||||
| OtherMiddleName: | LYNNE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777341 | ||||||||
| FaxNumber: | 8437777345 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 SOUTH RAVENEL STREET | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777341 | ||||||||
| FaxNumber: | 8437777345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2007 | ||||||||
| LastUpdateDate: | 03/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 28803 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101239343 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 071 | 01 | SC | BCBS | OTHER |