Provider Demographics
NPI:1275541468
Name:ANDREWS, PETER A (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:ANDREWS
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 1:47 STATE ST
Mailing Address - Street 2:
Mailing Address - City:STRUTHERS
Mailing Address - State:OH
Mailing Address - Zip Code:44471-1939
Mailing Address - Country:US
Mailing Address - Phone:330-755-3311
Mailing Address - Fax:
Practice Address - Street 1:47 STATE ST
Practice Address - Street 2:
Practice Address - City:STRUTHERS
Practice Address - State:OH
Practice Address - Zip Code:44471-1939
Practice Address - Country:US
Practice Address - Phone:330-722-3311
Practice Address - Fax:330-755-6656
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006790-A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2121868Medicaid
OH2121868Medicaid
OH0866302Medicare PIN