Individual
DR. GINA LARISSA AECKERSBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(937) 272-4976
Mailing address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-8905
(937) 272-4976
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
47374
TX
2080P0210X
Pediatric Nephrology Physician
Primary
89678
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
426932601
—
TX
01
—
426932602
CSHCN
TX
Enumeration date
05/25/2018
Last updated
05/02/2023
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