Provider Demographics
NPI:1801231634
Name:MIARA, MELISSA ANN (DO)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:MIARA
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 1:3617 CASEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-2981
Mailing Address - Country:US
Mailing Address - Phone:843-716-7911
Mailing Address - Fax:843-716-7918
Practice Address - Street 1:3617 CASEY ST STE C
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569
Practice Address - Country:US
Practice Address - Phone:843-716-7911
Practice Address - Fax:843-716-7918
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-07
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140060207R00000X, 208M00000X
SC82104207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist