Provider Demographics
NPI:1881604965
Name:ANDREW P HARAKAS MD PA
Entity type:Organization
Organization Name:ANDREW P HARAKAS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARAKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-488-9595
Mailing Address - Street 1:1552 N LIMESTONE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340
Mailing Address - Country:US
Mailing Address - Phone:864-488-9595
Mailing Address - Fax:864-488-9546
Practice Address - Street 1:1552 N LIMESTONE ST
Practice Address - Street 2:SUITE C
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340
Practice Address - Country:US
Practice Address - Phone:864-488-9595
Practice Address - Fax:864-488-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24069174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN33057Medicaid
SCN33057Medicaid