Provider Demographics
NPI:1821073016
Name:DRAISEN, ANDREA F (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:F
Last Name:DRAISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:STE 3000
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-224-1055
Mailing Address - Fax:864-224-3773
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:STE 3000
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-224-1055
Practice Address - Fax:864-224-3773
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10285208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102855Medicaid
GA000469741BMedicaid
SCGP5476Medicaid
B91485Medicare UPIN