Provider Demographics
NPI:1366442998
Name:CONCOFF, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CONCOFF
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 1:2141 N HARBOR BLVD STE 35000
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3831
Mailing Address - Country:US
Mailing Address - Phone:714-626-8630
Mailing Address - Fax:714-626-8659
Practice Address - Street 1:2141 N HARBOR BLVD STE 35000
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3831
Practice Address - Country:US
Practice Address - Phone:714-626-8630
Practice Address - Fax:714-626-8659
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55793207RR0500X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA55793DMedicare PIN
CAG82359Medicare UPIN