Provider Demographics
NPI:1629101688
Name:OLSON, CAMERON LEE (PA)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:LEE
Last Name:OLSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR
Mailing Address - Street 2:STE 150
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3261
Mailing Address - Country:US
Mailing Address - Phone:843-971-9350
Mailing Address - Fax:843-971-9351
Practice Address - Street 1:851 LEONARD FULGHUM DR STE 101
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3793
Practice Address - Country:US
Practice Address - Phone:843-971-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0751PAMedicaid
SC0751PAMedicaid
SCQ79247Medicare UPIN
SCAA18487840Medicare PIN
SCAA18489148Medicare PIN