Provider Demographics
NPI:1710555941
Name:BATTEN, MACELYN ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:MACELYN
Middle Name:ELIZABETH
Last Name:BATTEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10 WESTEDGE ST UNIT 703
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-6925
Mailing Address - Country:US
Mailing Address - Phone:910-840-7392
Mailing Address - Fax:
Practice Address - Street 1:19 HAGOOD AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-5120
Practice Address - Country:US
Practice Address - Phone:843-792-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMDO.83662LL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery