Provider Demographics
NPI:1104138072
Name:JAPITANA BUNNELL, MARIAN G (MD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:G
Last Name:JAPITANA BUNNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIAN AURORA
Other - Middle Name:GUINTU
Other - Last Name:JAPITANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:604 NORTH 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29550-4416
Mailing Address - Country:US
Mailing Address - Phone:843-332-6645
Mailing Address - Fax:843-332-9894
Practice Address - Street 1:906 W CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4416
Practice Address - Country:US
Practice Address - Phone:843-332-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35718208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics