Provider Demographics
NPI:1134217565
Name:ERVIN, ANN HARRIOTT FISHER (MD)
Entity type:Individual
Prefix:DR
First Name:ANN HARRIOTT
Middle Name:FISHER
Last Name:ERVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1706 ST. JULIANS PLACE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2410
Mailing Address - Country:US
Mailing Address - Phone:803-771-7506
Mailing Address - Fax:803-771-9455
Practice Address - Street 1:1706 ST. JULIANS PLACE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2410
Practice Address - Country:US
Practice Address - Phone:803-771-7506
Practice Address - Fax:803-771-9455
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL28990207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA42004810Medicare UPIN