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NPI Code Detail

MEDICARE: ANDRE MATTHEW AGASSI

MEDICARE: ANDRE MATTHEW AGASSI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician76627TN
2390200000XStudent in an Organized Health Care Education/Training ProgramNC

General Provider Information

NPI Number : 1760019277
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRE MATTHEW AGASSI
Provider Business Mailing Address
First Line : 2301 ERWIN RD
Second Line :
City : DURHAM
State : NC
Zip : 27705-4699
Country : US
Telephone Number : 919-684-8111
Fax Number :
Provider Business Practice Location Address
First Line : 4820 OLD KINGSTON PIKE
Second Line :
City : KNOXVILLE
State : TN
Zip : 37919-6424
Country : US
Telephone Number : 865-558-9862
Fax Number : 865-584-3478
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2020
Last Update Date : 06/12/2026

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