Individual
MARISSA BOETTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-4810
(434) 297-6029
Mailing address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0116038941
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/13/2023
Last updated
06/20/2024
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