Healthcare Provider Details

I. General information

NPI: 1225226517
Provider Name (Legal Business Name): ANDREW HAAS MCDERMOTT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 DENNY AVE
PASCAGOULA MS
39581-5301
US

IV. Provider business mailing address

1708 DENNY AVE
PASCAGOULA MS
39567-3303
US

V. Phone/Fax

Practice location:
  • Phone: 228-809-5000
  • Fax:
Mailing address:
  • Phone: 228-471-2273
  • Fax: 228-471-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00102
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: