Healthcare Provider Details

I. General information

NPI: 1194990093
Provider Name (Legal Business Name): XIAO M ANDROULAKIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK ROAD SUITE 420
COLUMBIA SC
29203-8004
US

IV. Provider business mailing address

3555 HARDEN STREET EXT 15 MEDICAL PARK, SUITE 300
COLUMBIA SC
29203-6894
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-6500
  • Fax: 803-545-6051
Mailing address:
  • Phone: 803-545-5017
  • Fax: 803-255-3451

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 StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number34467
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: