Provider Demographics
NPI:1992389480
Name:AYASSE, MARISSA T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:T
Last Name:AYASSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARISSA
Other - Middle Name:T
Other - Last Name:AYASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1 RIVERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4961
Mailing Address - Country:US
Mailing Address - Phone:540-581-0238
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4961
Practice Address - Country:US
Practice Address - Phone:540-581-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program