Provider Demographics
NPI:1821293093
Name:MARONEY, CONSTANCE LYNNE BELISSARY (MD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE LYNNE
Middle Name:BELISSARY
Last Name:MARONEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CONSTANCE
Other - Middle Name:LYNNE
Other - Last Name:BELISSARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7341
Mailing Address - Fax:843-777-7345
Practice Address - Street 1:101 SOUTH RAVENEL STREET
Practice Address - Street 2:SUITE 120
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2610
Practice Address - Country:US
Practice Address - Phone:843-777-7341
Practice Address - Fax:843-777-7345
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28803207R00000X
VA0101239343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC071OtherBCBS