Provider Demographics
NPI:1336142603
Name:ARCHER, ANDREW L (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:ARCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1 PRESTIGE PL
Mailing Address - Street 2:STE 550
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3794
Mailing Address - Country:US
Mailing Address - Phone:937-762-1310
Mailing Address - Fax:937-522-8493
Practice Address - Street 1:7700 WASHINGTON VILLAGE DR STE 130
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4094
Practice Address - Country:US
Practice Address - Phone:937-531-0195
Practice Address - Fax:937-531-0196
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006981A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2319217Medicaid
OH98259OtherNATIONWIDE HEALTH PLAN
OHD06981OtherHUMANA/CHOICECARE
OH34006981AOtherMEDICAL LICENSE
OH3805308OtherCIGNA
OH1702273OtherUNITED HEALTHCARE
OH421534506OtherCHAMPUS/TRICARE
OHP00133425OtherRAILROAD MEDICARE
OH445020003OtherCARESOURCE
OH7582436OtherAETNA
OH220226702OtherDEPT. OF LABOR WC
OH000000334026OtherANTHEM
OH445020003OtherCARESOURCE
OHAR4074576Medicare PIN
OHD06981OtherHUMANA/CHOICECARE
OH2319217Medicaid
OH7311891Medicare PIN