Individual provider · NPI-1

Dr. Gina Larissa Aeckersberg, MD

Pediatrics, Pediatric Nephrology · Charleston, SC

NPI number1992296818
StatusActive
Last updated in NPPESMay 2, 2023

Details

NPI
1992296818
Entity type
Individual (NPI-1)
Name
Dr. Gina Larissa Aeckersberg
Credential
MD
Sex
Female
Sole proprietor
No
Enumeration date
May 25, 2018
Certification date
May 2, 2023
Last updated
May 2, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2080P0210X Pediatrics, Pediatric Nephrology89678SCYes
208000000X Pediatrics47374TX

Practice location

169 Ashley Ave Rm 202
Charleston, SC 29425-8905

Phone 937-272-4976

Mailing address

169 Ashley Ave Rm 202
Charleston, SC 29425-8905

Phone 937-272-4976

Other practice locations

4502 Medical Dr
San Antonio, TX 78229-4402

Phone 210-562-5365 · Fax 210-358-2095

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