Healthcare Provider Details

I. General information

NPI: 1235471392
Provider Name (Legal Business Name): ANDREW TUDOR TRIFAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax: 704-834-2500
Mailing address:
  • Phone: 48-342-4507
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017-00369
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: