MEDICARE: MR. EUGENE ANCRUM II PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2439	SC
2	363A00000X	Physician Assistant	2439	SC
3	363AM0700X	Medical Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043694334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENE ANCRUM II PA

Provider Business Mailing Address
First Line	:	8720 DORCHESTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7303
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	8720 DORCHESTER RD
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-7303
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	04/09/2026

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