Provider Demographics
NPI:1760687370
Name:GHASSEMIAN, ANDREW JAFAR
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAFAR
Last Name:GHASSEMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10931 RAVEN RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6499
Mailing Address - Country:US
Mailing Address - Phone:919-870-6600
Mailing Address - Fax:919-870-1610
Practice Address - Street 1:10931 RAVEN RIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6499
Practice Address - Country:US
Practice Address - Phone:919-870-6600
Practice Address - Fax:919-870-1610
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00585207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2076183Medicare PIN
P00900208Medicare PIN