Provider Demographics
NPI:1033141718
Name:RICHARD, ANDREA J (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:J
Last Name:RICHARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4867
Mailing Address - Country:US
Mailing Address - Phone:814-728-8841
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN DR
Practice Address - Street 2:
Practice Address - City:NORTH WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5001
Practice Address - Country:US
Practice Address - Phone:814-726-4317
Practice Address - Fax:814-726-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007136L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE92297Medicare UPIN
610329Medicare PIN