Healthcare Provider Details

I. General information

NPI: 1316920358
Provider Name (Legal Business Name): ILYA M AVERBUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2669 KINARD ST, NEWBERRY, SC 29108
NEWBERRY SC
29108
US

IV. Provider business mailing address

2 FALCON DR APT 200
HOLLAND PA
18966-2945
US

V. Phone/Fax

Practice location:
  • Phone: 803-276-7570
  • Fax:
Mailing address:
  • Phone: 215-953-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-068971
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD032400E
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82300
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD032400E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: