Provider Demographics
NPI:1255303525
Name:MUELENAER, ANDRE JR (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:MUELENAER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HIGHLAND AVE SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:SUITE 203
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2256
Practice Address - Country:US
Practice Address - Phone:540-985-9835
Practice Address - Fax:540-985-4018
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-047216208000000X, 2080P0214X
NC293532080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6747680Medicaid
VA370004916Medicare PIN
VA6747680Medicaid
VA370001052Medicare PIN
VAC85666Medicare UPIN