Provider Demographics
NPI:1205854593
Name:ASHBY, ANDREA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:ELAINE
Last Name:ASHBY
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 1:3182 OLD TUNNEL RD D
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4152
Mailing Address - Country:US
Mailing Address - Phone:925-283-1210
Mailing Address - Fax:
Practice Address - Street 1:3182 OLD TUNNEL RD D
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4152
Practice Address - Country:US
Practice Address - Phone:925-283-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2017-10-24
Deactivation Date:2017-10-09
Deactivation Code:
Reactivation Date:2017-10-24
Provider Licenses
StateLicense IDTaxonomies
CAG51940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF19872Medicare UPIN