Provider Demographics
NPI:1417954173
Name:FERENCE, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FERENCE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 2ND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7889
Mailing Address - Country:US
Mailing Address - Phone:843-793-6980
Mailing Address - Fax:
Practice Address - Street 1:21601 76TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7507
Practice Address - Country:US
Practice Address - Phone:425-640-4000
Practice Address - Fax:425-774-2688
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038526207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAUS2544114OtherAETNA SPECIALIST PIN VM
WA8286940Medicaid
WA3224FEOtherBLUE SHIELD VM
AKMD8793Medicaid
AKMD8793Medicaid
WAUS2544114OtherAETNA SPECIALIST PIN VM
WAH45615Medicare UPIN