Provider Demographics
NPI:1336304708
Name:SUSAN ANDRACCHI MD PA
Entity Type:Organization
Organization Name:SUSAN ANDRACCHI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRACCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-202-1067
Mailing Address - Street 1:2512 DELANEY RD
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:910-343-0171
Practice Address - Street 1:2512 DELANEY RD
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:910-202-1067
Practice Address - Fax:910-343-0171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare UPIN