Provider Demographics
NPI:1013989094
Name:KISS, ANDREA T (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:T
Last Name:KISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:T
Other - Last Name:SZABO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751274
Mailing Address - Street 2:ATTN: PRMO PROVIDER ENROLLMENT
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5107 S PARK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8400
Practice Address - Country:US
Practice Address - Phone:919-471-1518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130RJMedicaid
NC89130RJMedicaid
NC89130RJMedicaid
BK5528255OtherFEDERAL DEA