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General NPI Number Information
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NPI Number | 1073325445
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Entity Type | Individual
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Provider Name | ANDREA MAE DORSCH DOUB PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 607 S MAIN ST UNIT E
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City | KING
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State | NC
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Zip | 27021-9016
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Country | US
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Telephone | 336-983-9111
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WOLF ROCK RD
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City | WALNUT COVE
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State | NC
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Zip | 27052-5754
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Country | US
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Telephone | 336-407-6021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-15009
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License Number State | NC
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