Provider Demographics
NPI:1093121980
Name:MUCCI, ANDREA DAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DAWN
Last Name:MUCCI
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 1:9500 EUCLID AVE # R3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-7987
Mailing Address - Fax:216-636-6761
Practice Address - Street 1:9500 EUCLID AVE # R3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1716
Practice Address - Country:US
Practice Address - Phone:216-444-7987
Practice Address - Fax:216-636-6761
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1245282080P0205X, 208000000X
OH57-0240022080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty