Andrea Denise Boan, PA-C, PHD

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3679 Issued in SC

Practice address

12 Commercial Row Apt a
Charleston, SC 29412-3641

Phone

(864) 506-2319

NPI assigned

Sep 2, 2020

Last updated

Oct 22, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1083228514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 RUTLEDGE AVE # MSC561",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294258903",
            "telephone_number": "843-876-1064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 COMMERCIAL ROW APT A",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294123641",
            "telephone_number": "864-506-2319"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "135 Rutledge Ave # Msc561",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294258903",
            "country_code": "US",
            "telephone_number": "843-876-1064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOAN",
        "first_name": "ANDREA",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "PA-C, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Colin Blumenthal, MD MS
• Laurence Steven Blumenthal, M.D.
• Alisa Nicole Blumenthaler, MD
• Suzanne Robbins Blumer, CRNA
• Laura Christine Boaman, MS CMHC, LPCA
• Harry Wade Boatwright, M.D.
• John G Boatwright, MD
• Sarah Wade Boatwright, MD
• Alexi Madison Bobba, PA
• Jacob Bobba, PA

• Physician Assistant in Charleston, SC
• Providers in Charleston, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.