Healthcare Provider Details

I. General information

NPI: 1225590805
Provider Name (Legal Business Name): ANDREW GLEN ROBINSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 12/07/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

598 GEIGER BLVD
BEAUFORT SC
29904
US

IV. Provider business mailing address

598 GEIGER BLVD
BEAUFORT SC
29904
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-7424
  • Fax: 843-228-5352
Mailing address:
  • Phone: 843-228-7424
  • Fax: 843-228-5352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101270545
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: