Provider Demographics
NPI:1376558007
Name:GIARRIZZI, MARK A (PAC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:GIARRIZZI
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730
Mailing Address - Country:US
Mailing Address - Phone:803-329-1930
Mailing Address - Fax:803-328-2549
Practice Address - Street 1:760 ADDISON AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-329-1930
Practice Address - Fax:803-328-2549
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0433PAMedicaid
SC0433PAMedicaid