Provider Demographics
NPI:1700400496
Name:LAUGHREY, MARISA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:MICHELLE
Last Name:LAUGHREY
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER
Mailing Address - Street 2:14 MEDICAL PARK, STE 400
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-6155
Mailing Address - Fax:803-434-6979
Practice Address - Street 1:PRISMA HEALTH CHILDREN'S HOSPITAL OUTPATIENT CENTER
Practice Address - Street 2:14 MEDICAL PARK, STE 400
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-6155
Practice Address - Fax:803-434-6979
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL84169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics