Healthcare Provider Details

I. General information

NPI: 1942200407
Provider Name (Legal Business Name): MARK PRESTON ANDROES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 EDGEWOOD DR
GREENVILLE SC
29605-4235
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7861
  • Fax: 864-241-9242
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number24442
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: