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Individual

MS. GINA MAGGIANO FISHBURNE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
2910 TRICOM ST, NORTH CHARLESTON, SC 29406-9350
(843) 572-9211
(843) 572-0457
Mailing address
PO BOX 751874, CHARLOTTE, NC 28275-1874
(843) 402-5200
(843) 402-5296

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5544
SC
363A00000X
Physician Assistant
NC 102864
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0243PA
SC
01
D7502
MEDCOST
NC
Enumeration date
03/23/2006
Last updated
11/25/2024
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