Provider Demographics
NPI:1851370266
Name:ANDRADE, REGAN M (MD)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:M
Last Name:ANDRADE
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 1:21875 STATE HIGHWAY 181
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-4481
Mailing Address - Country:US
Mailing Address - Phone:251-928-1442
Mailing Address - Fax:251-210-0969
Practice Address - Street 1:21875 STATE HIGHWAY 181
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-4481
Practice Address - Country:US
Practice Address - Phone:251-928-1442
Practice Address - Fax:251-210-0969
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054579A207Q00000X
AL27544207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200346320AMedicaid
IN200346320AMedicaid
H06405Medicare UPIN