Provider Demographics
NPI:1457389793
Name:BELL, ANDRE E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:E
Last Name:BELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10211 ALM ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8221
Practice Address - Country:US
Practice Address - Phone:919-484-8345
Practice Address - Fax:919-419-8218
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051910207Q00000X
NC2011-00985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917979Medicaid
GA000967777AMedicaid
GA000967777AMedicaid
NC5917979Medicaid
NCNC0901AMedicare PIN