Provider Demographics
NPI:1790707784
Name:MCGRATH, ANDREA MEMMEN (M D)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MEMMEN
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MEMMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5950 FAIRVIEW RD STE 330
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-2108
Mailing Address - Country:US
Mailing Address - Phone:704-495-6334
Mailing Address - Fax:704-817-7219
Practice Address - Street 1:10344 PARK RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8505
Practice Address - Country:US
Practice Address - Phone:704-495-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1790707784Medicaid
SCN00096Medicaid
NC891267KMedicaid
NC1267KOtherBCBS
NC110245320Medicare PIN
NC1267KOtherBCBS
H27844Medicare UPIN
NC2280916LMedicare PIN
NC2280916GMedicare PIN
NC1790707784Medicaid