Provider Demographics
NPI:1013965532
Name:COMIANOS, MARC JAMES (DO)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JAMES
Last Name:COMIANOS
Suffix:
Gender:M
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: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:843-390-8320
Mailing Address - Fax:843-390-8329
Practice Address - Street 1:3980 HIGHWAY 9 E STE 100
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8163
Practice Address - Country:US
Practice Address - Phone:843-390-8320
Practice Address - Fax:843-390-8329
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004891C207R00000X
SC1431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000118340OtherANTHEM
0400998OtherUHC
0673973OtherPALMETTO MEDICARE
353077OtherSUBMITTER NO
635999OtherAETNA
SC014317Medicaid
110071156OtherTRAVELERS MEDICARE
311098079029OtherCIGNA
OH0871730Medicaid
OH0673973Medicare ID - Type Unspecified
OH000000118340OtherANTHEM
E76462Medicare UPIN