Provider Demographics
NPI:1336103704
Name:WAKER, ANDREA E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:WAKER
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 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:330-923-0553
Mailing Address - Fax:330-923-0556
Practice Address - Street 1:96 GRAHAM RD
Practice Address - Street 2:SUITE B
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1205
Practice Address - Country:US
Practice Address - Phone:330-923-0553
Practice Address - Fax:330-923-0556
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-075855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2119175Medicaid
OH2119175Medicaid
OHWA0880783Medicare ID - Type Unspecified