Provider Demographics
NPI:1497719355
Name:MCMARLIN, ANDREW J (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:MCMARLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 HOUSTON NORTHCUTT BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3487
Mailing Address - Country:US
Mailing Address - Phone:843-471-0375
Mailing Address - Fax:
Practice Address - Street 1:966 HOUSTON NORTHCUTT BLVD STE E
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3487
Practice Address - Country:US
Practice Address - Phone:843-471-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-16
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1530207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC015307Medicaid
SCP01146294OtherRR MEDICARE
SCAA80817126Medicare PIN
SCI64466Medicare UPIN