Provider Demographics
NPI:1225222680
Name:ALISANGCO, MARCIE M (DO)
Entity type:Individual
Prefix:MRS
First Name:MARCIE
Middle Name:M
Last Name:ALISANGCO
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:BETH
Other - Last Name:MASSARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1350 WALTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2612
Mailing Address - Country:US
Mailing Address - Phone:706-774-8326
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR STE 550
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4843
Practice Address - Country:US
Practice Address - Phone:803-936-7140
Practice Address - Fax:803-936-7412
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC92696207RR0500X
GA063756207RR0500X
GA63756207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA063756OtherGEORGIA COMPOSITE BOARD