Provider Demographics
NPI:1164579785
Name:ANDREW, CLIFFORD GEORGE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:GEORGE
Last Name:ANDREW
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1517
Mailing Address - Country:US
Mailing Address - Phone:410-987-6789
Mailing Address - Fax:
Practice Address - Street 1:645 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3931
Practice Address - Country:US
Practice Address - Phone:410-647-5000
Practice Address - Fax:419-647-5010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00242902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD785791800Medicaid
MD785791800Medicaid
MD1286Medicare PIN