Basic Information
Provider Information
NPI: 1811366396
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANDREAGGI
FirstName: DAVID
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AU.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3240 WASHINGTON RD
Address2: SUITE 240
City: MC MURRAY
State: PA
PostalCode: 153173180
CountryCode: US
TelephoneNumber: 7249414434
FaxNumber: 7249414714
Practice Location
Address1: 3240 WASHINGTON RD
Address2: SUITE 240
City: MC MURRAY
State: PA
PostalCode: 153173180
CountryCode: US
TelephoneNumber: 7249414434
FaxNumber: 7249414714
Other Information
ProviderEnumerationDate: 09/15/2015
LastUpdateDate: 09/15/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAT006436PAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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