Provider Demographics
NPI:1912176140
Name:MARISCALCO, MICHAEL WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:MARISCALCO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:4710 PUDDLEDOCK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1237
Practice Address - Country:US
Practice Address - Phone:804-732-0095
Practice Address - Fax:804-732-0055
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2020-09-12
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Provider Licenses
StateLicense IDTaxonomies
OH57.012988207X00000X
VA0101254090207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery