Individual
ANDREA T KISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5107 S PARK DR, SUITE 205, DURHAM, NC 27713-8400
(919) 471-1518
Mailing address
PO BOX 751274, ATTN: PRMO PROVIDER ENROLLMENT, CHARLOTTE, NC 28275-1274
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
200101228
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89130RJ
—
NC
Enumeration date
02/03/2006
Last updated
03/07/2023
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