Provider Demographics
NPI:1720127566
Name:FLORES, MARISA C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:C
Last Name:FLORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:C
Other - Last Name:FLORES KATHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:908 S WILLIAMSON AVE
Mailing Address - Street 2:
Mailing Address - City:ELON
Mailing Address - State:NC
Mailing Address - Zip Code:27244-9280
Mailing Address - Country:US
Mailing Address - Phone:336-538-2416
Mailing Address - Fax:336-538-2395
Practice Address - Street 1:908 S WILLIAMSON AVE
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9280
Practice Address - Country:US
Practice Address - Phone:336-538-2416
Practice Address - Fax:336-538-2395
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0012208000000X
NC2010-01589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H27491Medicare UPIN