| Dr Kelly Elaine Shaffer, MD | |
|
2687 Lake Park Dr, North Charleston, SC 29406-9100 | |
| (843) 572-1010 | |
| (843) 569-1719 |
| Full Name | Dr Kelly Elaine Shaffer |
|---|---|
| Gender | Female |
| Speciality | Urology |
| Experience | 22 Years |
| Location | 2687 Lake Park Dr, North Charleston, South Carolina |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710060017 | NPI | - | NPPES |
| 28461 | Other | SC | SC MEDICAL LICENSE |
| 273905550 | Other | NC | NC MED BOARD # 153519 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208800000X | Urology | 2008-02041 (North Carolina) | Primary |
| 208800000X | Urology | LL28461 (South Carolina) | Secondary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Trident Medical Center | Charleston, SC | Hospital |
| Mount Pleasant Hospital | Mount pleasant, SC | Hospital |
| East Cooper Medical Center | Mount pleasant, SC | Hospital |
| Bon Secours-st Francis Xavier Hospital | Charleston, SC | Hospital |
| Roper St Francis Hospital-berkely Inc | Moncks corner, SC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Lowcountry Urology Clinics, Pa | 6406869247 | 14 |
| Entity Name | Lowcountry Urology Clinics, Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942242714 PECOS PAC ID: 6406869247 Enrollment ID: O20060724000104 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Kelly Elaine Shaffer, MD 1300 Hospital Dr, Mount Pleasant, SC 29464-3261 Ph: (843) 884-9646 | Dr Kelly Elaine Shaffer, MD 2687 Lake Park Dr, North Charleston, SC 29406-9100 Ph: (843) 572-1010 |
Dr. Nelson Randolph Ploch, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2890 Tricom Street, North Charleston, SC 29406 Phone: 843-797-6600 Fax: 843-820-1440 | |
Dr. Samuel Walker Nickles, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2890 Tricom St, North Charleston, SC 29406 Phone: 843-797-6600 Fax: 843-820-1440 | |
Dr. Taylor B Vaughan, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 2890 Tricom St, North Charleston, SC 29406 Phone: 843-797-6600 Fax: 843-820-1440 | |
Dr. Frederick James Goulding, M.D. Urology Medicare: Not Enrolled in Medicare Practice Location: 2890 Tricom Street, North Charleston, SC 29406 Phone: 843-797-6600 Fax: 843-820-1440 | |
Dr. Theodore Edward Brisson, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2890 Tricom Street, North Charleston, SC 29406 Phone: 843-797-6600 Fax: 843-820-1440 | |
Dr. Marshall Scott Wingo, M.D. Urology Medicare: Accepting Medicare Assignments Practice Location: 2687 Lake Park Dr, North Charleston, SC 29406 Phone: 843-572-1010 Fax: 843-569-1719 |