Provider Demographics
NPI:1154813194
Name:ADLER, ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N TRADE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1729
Mailing Address - Country:US
Mailing Address - Phone:704-841-4000
Mailing Address - Fax:704-841-4338
Practice Address - Street 1:428 N TRADE ST STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1729
Practice Address - Country:US
Practice Address - Phone:704-841-4000
Practice Address - Fax:704-841-4338
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC727213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLXJBH66971125OtherBLUE CROSS BLUE SHIELD