Provider Demographics
NPI:1346290590
Name:ANDRUS & ASSOCIATES DERMATOLOGY, PA
Entity Type:Organization
Organization Name:ANDRUS & ASSOCIATES DERMATOLOGY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:ANDRUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:919-782-3782
Mailing Address - Street 1:3809 COMPUTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6518
Mailing Address - Country:US
Mailing Address - Phone:919-782-3782
Mailing Address - Fax:919-782-3788
Practice Address - Street 1:3809 COMPUTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6518
Practice Address - Country:US
Practice Address - Phone:919-782-3782
Practice Address - Fax:919-782-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75355207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0186JOtherNC BLUECROSS BLUESHIELD
NC152279OtherMEDCOST
NC890186JMedicaid
NC2321110Medicare ID - Type Unspecified