Provider Demographics
NPI:1619973120
Name:ANDREASSIAN, GREGORY D (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:ANDREASSIAN
Suffix:
Gender:M
Credentials:MD,PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:STE 130
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4478
Mailing Address - Country:US
Mailing Address - Phone:830-997-6773
Mailing Address - Fax:830-997-1961
Practice Address - Street 1:205 W WINDCREST ST STE 130
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4478
Practice Address - Country:US
Practice Address - Phone:830-997-6773
Practice Address - Fax:830-997-1961
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0136208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A5001Medicare UPIN