Provider Demographics
NPI:1942386032
Name:FRITSCHLE, ANDREA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:FRITSCHLE
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-0208
Mailing Address - Country:US
Mailing Address - Phone:703-766-6555
Mailing Address - Fax:800-731-6158
Practice Address - Street 1:670 PLACERVILLE DR STE 2
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-4200
Practice Address - Country:US
Practice Address - Phone:530-644-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC288862084P0800X
GA0659672084P0800X
SCLL288862084P0800X
FLME1138052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC288860Medicaid
SCAA25803353Medicare PIN
SCAA6418Medicare UPIN
SCAA25803353Medicare UPIN