Provider Demographics
NPI:1730134792
Name:SASSER, MARSHALL CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:CRAIG
Last Name:SASSER
Suffix:
Gender:M
Credentials:MD
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 50757
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-0013
Mailing Address - Country:US
Mailing Address - Phone:843-347-8600
Mailing Address - Fax:843-347-8702
Practice Address - Street 1:394 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9150
Practice Address - Country:US
Practice Address - Phone:843-347-8765
Practice Address - Fax:843-347-3499
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4828208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4522Medicaid
SCP00391756OtherRAILROAD MEDICARE