Provider Demographics
NPI:1174588263
Name:CALCUTT, ANDREW FENTERS (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:FENTERS
Last Name:CALCUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:901 ROBERTSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-3171
Mailing Address - Country:US
Mailing Address - Phone:843-549-8003
Mailing Address - Fax:843-549-8006
Practice Address - Street 1:901 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-3171
Practice Address - Country:US
Practice Address - Phone:843-549-8003
Practice Address - Fax:843-549-8006
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20022208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC161633693OtherBCBS
SC20037555OtherFIRST CHOICE/SELECT HEALT
SCGP3585Medicaid
SC161633693OtherTRICARE
SC161633693OtherBCBS
SCG77359Medicare UPIN