Provider Demographics
NPI:1376809111
Name:MARIETTA, AMY ELEANOR (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:ELEANOR
Last Name:MARIETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 HENDERSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2868
Mailing Address - Country:US
Mailing Address - Phone:828-771-5500
Mailing Address - Fax:828-257-4750
Practice Address - Street 1:119 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2868
Practice Address - Country:US
Practice Address - Phone:828-771-5500
Practice Address - Fax:828-257-4750
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2025-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-01569207Q00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN