Healthcare Provider Details

I. General information

NPI: 1891624805
Provider Name (Legal Business Name): ANSLEY OXFORD BALOGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1497 THERESA DR
CHARLESTON SC
29412-3219
US

IV. Provider business mailing address

1497 THERESA DR
CHARLESTON SC
29412-3219
US

V. Phone/Fax

Practice location:
  • Phone: 205-777-1982
  • Fax:
Mailing address:
  • Phone: 205-777-1982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number285863
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: