Provider Demographics
NPI:1659336444
Name:ANDREW H. WOLDORF MD
Entity Type:Organization
Organization Name:ANDREW H. WOLDORF MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:WOLDORF
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:803-790-9002
Mailing Address - Street 1:4840 FOREST DR
Mailing Address - Street 2:PMB 350
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29206-4810
Mailing Address - Country:US
Mailing Address - Phone:803-790-9002
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23177207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4304Medicaid
SC0281Medicare PIN