Provider Demographics
NPI:1790733590
Name:ANSLEY, JOHN FITZGERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FITZGERALD
Last Name:ANSLEY
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 1:832 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2126
Mailing Address - Country:US
Mailing Address - Phone:803-536-5511
Mailing Address - Fax:803-536-0636
Practice Address - Street 1:832 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2126
Practice Address - Country:US
Practice Address - Phone:803-536-5511
Practice Address - Fax:803-536-0636
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21712207Y00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA2835Medicaid
SC2022Medicare PIN
SCPA2835Medicaid