Individual
MARTIN C MIRRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1333 TAYLOR STREET, STE 3A, COLUMBIA, SC 29201
(803) 254-4707
(803) 254-1198
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19670
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
196709
—
SC
Enumeration date
08/31/2006
Last updated
05/18/2018
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