MEDICARE: MR. ERIC ANDREAE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	027340	GA

General Provider Information

NPI Number	:	1811100688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC ANDREAE M.D.

Provider Business Mailing Address
First Line	:	415 COTTAGE EMERGENCY # 259
Second Line	:	WEST 29TH ST.
City	:	SEA ISLAND
State	:	GA
Zip	:	31561
Country	:	US
Telephone Number	:	912-466-8909
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 HAMPTON AVE
Second Line	:	SUITE 6
City	:	BRUNSWICK
State	:	GA
Zip	:	31520-4224
Country	:	US
Telephone Number	:	912-466-8909
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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