Provider Demographics
NPI:1780808931
Name:WARD, ANDREA R (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:WARD
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2800 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6478
Mailing Address - Country:US
Mailing Address - Phone:919-784-7110
Mailing Address - Fax:919-784-7111
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:SUITE 403
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6478
Practice Address - Country:US
Practice Address - Phone:919-784-7110
Practice Address - Fax:919-784-7111
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-11-22
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Provider Licenses
StateLicense IDTaxonomies
SC890363AS0400X
MO2024045093363AS0400X
NC0010-01988363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762125Medicare PIN