Healthcare Provider Details

I. General information

NPI: 1801626080
Provider Name (Legal Business Name): ANDREW MILLER DELBRIDGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2024
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WH SMITH BLVD
GREENVILLE NC
27834-3763
US

IV. Provider business mailing address

8601 CARILEPH CT
RALEIGH NC
27615-8125
US

V. Phone/Fax

Practice location:
  • Phone: 919-880-8298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number001015762
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: