Provider Demographics
NPI:1770762551
Name:GREGORY D. ANDREASSIAN M.D., P.A.
Entity type:Organization
Organization Name:GREGORY D. ANDREASSIAN M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANDREASSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-997-6773
Mailing Address - Street 1:205 W WINDCREST ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-4479
Mailing Address - Country:US
Mailing Address - Phone:830-997-6773
Mailing Address - Fax:830-997-1961
Practice Address - Street 1:205 W WINDCREST ST
Practice Address - Street 2:SUITE 220
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4479
Practice Address - Country:US
Practice Address - Phone:830-997-6773
Practice Address - Fax:830-997-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00857UMedicare UPIN