Provider Demographics
NPI:1235401340
Name:MARI ASPER MD, LLC
Entity Type:Organization
Organization Name:MARI ASPER MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ASPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-621-1333
Mailing Address - Street 1:9263 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7109
Mailing Address - Country:US
Mailing Address - Phone:843-377-1600
Mailing Address - Fax:843-277-1601
Practice Address - Street 1:9263 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7109
Practice Address - Country:US
Practice Address - Phone:843-377-1600
Practice Address - Fax:843-277-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-04
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29858261QM0801X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility