Provider Demographics
NPI:1689670135
Name:CREESE, ANDRE T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:T
Last Name:CREESE
Suffix:
Gender:M
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:PO BOX 100567
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0567
Mailing Address - Country:US
Mailing Address - Phone:843-777-5813
Mailing Address - Fax:843-777-5035
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-777-2027
Practice Address - Fax:843-777-5035
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC020497207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC204978Medicaid
SCG79136Medicare UPIN
SC204978Medicaid