Healthcare Provider Details

I. General information

NPI: 1902334105
Provider Name (Legal Business Name): ANDRA OPRISAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HENRY TECKLENBURG DR
CHARLESTON SC
29414-5733
US

IV. Provider business mailing address

PO BOX 603484
CHARLOTTE NC
28260-3484
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-1436
  • Fax: 843-402-1833
Mailing address:
  • Phone: 803-765-1838
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41106
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41106
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: