Provider Demographics
NPI:1265666085
Name:HOUSHOLDER, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:HOUSHOLDER
Suffix:
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 1:2700 HIGHWAY 280 S STE 460E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35223-5407
Mailing Address - Country:US
Mailing Address - Phone:205-772-9595
Mailing Address - Fax:205-395-6643
Practice Address - Street 1:2700 HIGHWAY 280 S STE 460E
Practice Address - Street 2:
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35223-5407
Practice Address - Country:US
Practice Address - Phone:205-772-9595
Practice Address - Fax:205-395-6643
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 114660207P00000X
NC2016-00905207P00000X
ALMD.30752207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCS483BMedicare PIN