Provider Demographics
NPI:1568463610
Name:WRIGHT, MARIE CELESTE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:CELESTE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 PAVILLION AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1646
Mailing Address - Country:US
Mailing Address - Phone:803-799-5015
Mailing Address - Fax:803-799-5098
Practice Address - Street 1:707 PAVILLION AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1646
Practice Address - Country:US
Practice Address - Phone:803-799-5015
Practice Address - Fax:803-799-5098
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9111207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC009111Medicaid
SC009111Medicaid