Provider Demographics
NPI:1205835915
Name:ANDRACCHI, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ANDRACCHI
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 1:2512 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6002
Mailing Address - Country:US
Mailing Address - Phone:910-202-1067
Mailing Address - Fax:910-202-1942
Practice Address - Street 1:2512 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6002
Practice Address - Country:US
Practice Address - Phone:910-202-1967
Practice Address - Fax:910-202-1942
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700845207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901697Medicaid
NC10697OtherBCBS
2242194AMedicare PIN
NC10697OtherBCBS