Provider Demographics
NPI:1093821977
Name:PHILLIPS, ANDREA R (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 PENNSYLVANIA AVE
Mailing Address - Street 2:#160
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3659
Mailing Address - Country:US
Mailing Address - Phone:301-888-2233
Mailing Address - Fax:301-888-9133
Practice Address - Street 1:23140 MOAKLEY ST STE 4
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2923
Practice Address - Country:US
Practice Address - Phone:301-997-1029
Practice Address - Fax:301-997-1489
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR127440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD302302800Medicaid
P48036Medicare UPIN
008835G75Medicare ID - Type Unspecified
MD082NR610Medicare UPIN