Provider Demographics
NPI:1679581326
Name:O'CONNOR, ANDREW S (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:S
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BAXTER ST STE 215
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3106
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:1640 CAMPUS PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5283
Practice Address - Country:US
Practice Address - Phone:704-226-0366
Practice Address - Fax:704-226-9535
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007397207RN0300X
NC2008-00276207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2411125Medicaid
NC2401631Medicare PIN
NC2401631AMedicare PIN
OH2411125Medicaid