Healthcare Provider Details

I. General information

NPI: 1760122949
Provider Name (Legal Business Name): AMBAR MARIE COLON GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E GREENVILLE ST STE 2800
ANDERSON SC
29621-1722
US

IV. Provider business mailing address

2000 E GREENVILLE ST STE 2800
ANDERSON SC
29621-1722
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-7636
  • Fax:
Mailing address:
  • Phone: 864-512-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL87964
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: