Provider Demographics
NPI:1376508176
Name:WOLDORF, ANDREW H (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
Last Name:WOLDORF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 HARDEN STREET EXT
Mailing Address - Street 2:15 MEDICAL PARK, SUITE 300
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6894
Mailing Address - Country:US
Mailing Address - Phone:803-434-6410
Mailing Address - Fax:803-434-1537
Practice Address - Street 1:4840 FOREST DR
Practice Address - Street 2:PMB #350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4810
Practice Address - Country:US
Practice Address - Phone:803-790-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23177207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT73408Medicaid
SC23177OtherWOLDORF STATE LICENSE #
SC23177OtherWOLDORF STATE LICENSE #
SCH197680281Medicare PIN
SC203178255OtherEIN
SC23177OtherWOLDORF STATE LICENSE #