Provider Demographics
NPI:1558343897
Name:LIVIGNI, MARIE P (DO)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:P
Last Name:LIVIGNI
Suffix:
Gender:F
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:PO BOX 261954
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29528-6054
Mailing Address - Country:US
Mailing Address - Phone:843-349-6543
Mailing Address - Fax:
Practice Address - Street 1:204 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8834
Practice Address - Country:US
Practice Address - Phone:843-349-6543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1573207R00000X
CT038288207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC015735Medicaid
SCAA94508552OtherMEDICARE PTAN