Provider Demographics
NPI:1760474456
Name:OLIVER, ANDREW BLAINE JR (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BLAINE
Last Name:OLIVER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:315 E GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3919
Mailing Address - Country:US
Mailing Address - Phone:704-484-5100
Mailing Address - Fax:704-484-5220
Practice Address - Street 1:200 S POST RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6269
Practice Address - Country:US
Practice Address - Phone:704-484-5100
Practice Address - Fax:704-484-5118
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC27960207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891044AMedicaid
NC891044AMedicaid
NC203381EMedicare PIN