Healthcare Provider Details

I. General information

NPI: 1881622272
Provider Name (Legal Business Name): ANDREW W PIASECKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 E HOSPITAL DR STE 140&350
WEST COLUMBIA SC
29169-4800
US

IV. Provider business mailing address

PO BOX 6069
WEST COLUMBIA SC
29171-6069
US

V. Phone/Fax

Practice location:
  • Phone: 803-936-7966
  • Fax: 803-936-7938
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number23684
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: