Provider Demographics
NPI:1184816746
Name:MAMMARAPPALLIL, MARISA C (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:C
Last Name:MAMMARAPPALLIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4191 MENDENHALL OAKS PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8035
Mailing Address - Country:US
Mailing Address - Phone:336-664-6175
Mailing Address - Fax:
Practice Address - Street 1:4191 MENDENHALL OAKS PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8035
Practice Address - Country:US
Practice Address - Phone:336-664-6175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01454207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology