Provider Demographics
NPI:1235132630
Name:ANDRES, DAVID M (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:ANDRES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3742 STATE ROUTE 257
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346
Mailing Address - Country:US
Mailing Address - Phone:814-678-3343
Mailing Address - Fax:814-678-5220
Practice Address - Street 1:3742 STATE ROUTE 257
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346
Practice Address - Country:US
Practice Address - Phone:814-678-3343
Practice Address - Fax:814-678-5220
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008083-L207R00000X
PAOS008083L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15903040007Medicaid
PA0015903040007Medicaid
F90704Medicare UPIN
PA446307Medicare ID - Type Unspecified
PA0015903040007Medicaid