Provider Demographics
NPI:1801962246
Name:RICE, ANDREA SIMMONS (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SIMMONS
Last Name:RICE
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 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7752 GATEWAY LN NW STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-4421
Practice Address - Country:US
Practice Address - Phone:704-316-4950
Practice Address - Fax:704-316-4951
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401480208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891188JMedicaid
NC2213136AMedicare PIN
NCG06050Medicare UPIN