MEDICARE: YEVGENIY GELFAND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	29076	SC
2	2084P0805X	Geriatric Psychiatry Physician	29076	SC
3	2084P0800X	Psychiatry Physician	29076	SC

General Provider Information

NPI Number	:	1013005495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIY GELFAND MD

Provider Business Mailing Address
First Line	:	9330 MEDICAL PLAZA DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29406-9104
Country	:	US
Telephone Number	:	843-847-3225
Fax Number	:	843-847-3247

Provider Business Practice Location Address
First Line	:	67 PRESIDENT ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-5712
Country	:	US
Telephone Number	:	843-792-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/17/2019

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