Healthcare Provider Details

I. General information

NPI: 1013005495
Provider Name (Legal Business Name): YEVGENIY GELFAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

IV. Provider business mailing address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-0111
  • Fax:
Mailing address:
  • Phone: 843-847-3225
  • Fax: 843-847-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29076
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number29076
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number29076
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: