Provider Demographics
NPI:1225222680
Name:ALISANGCO, MARCIE BETH MASSARO (DO)
Entity Type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:BETH MASSARO
Last Name:ALISANGCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:BETH
Other - Last Name:MASSARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1350 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2612
Mailing Address - Country:US
Mailing Address - Phone:706-774-8326
Mailing Address - Fax:
Practice Address - Street 1:820 SAINT SEBASTIAN WAY
Practice Address - Street 2:SUITE 4C
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2643
Practice Address - Country:US
Practice Address - Phone:706-774-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063756207RR0500X, 207RR0500X
GA63756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA063756OtherGEORGIA COMPOSITE BOARD