Provider Demographics
NPI:1033475074
Name:ANDEREGG, KATHERINE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANN
Last Name:ANDEREGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 601
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN'S ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29482-0601
Mailing Address - Country:US
Mailing Address - Phone:843-883-3336
Mailing Address - Fax:843-883-3336
Practice Address - Street 1:1730 THOMPSON AVENUE
Practice Address - Street 2:APT. C
Practice Address - City:SULLIVAN'S ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29482-0601
Practice Address - Country:US
Practice Address - Phone:843-883-3336
Practice Address - Fax:843-883-3336
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22183208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice