Provider Demographics
NPI:1366467607
Name:KUNDRAT, ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:KUNDRAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:410-402-2379
Mailing Address - Fax:410-469-3085
Practice Address - Street 1:3110 GRACEFIELD RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1820
Practice Address - Country:US
Practice Address - Phone:301-572-8340
Practice Address - Fax:301-572-8403
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0036716207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9680-0060OtherCAREFIRST BCBS OF DC
MD209821100Medicaid
04-58254OtherEVERCARE
522888-03OtherCAREFIRST BCBS OF MD
522096682004OtherTRICARE
522096682004OtherTRICARE
522888-03OtherCAREFIRST BCBS OF MD
B60990Medicare UPIN