Provider Demographics
NPI:1003201781
Name:BURRISS, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BURRISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 PONDFIELD RD STE A3
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-9522
Mailing Address - Country:US
Mailing Address - Phone:803-405-7140
Mailing Address - Fax:
Practice Address - Street 1:2580 HAYMAKER RD STE 201
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3500
Practice Address - Country:US
Practice Address - Phone:412-856-7500
Practice Address - Fax:412-856-6079
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC84696207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty