Provider Demographics
NPI:1376512434
Name:BRITTAN, ANDREW M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:BRITTAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 POPLAR AVE
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105
Mailing Address - Country:US
Mailing Address - Phone:901-287-5674
Mailing Address - Fax:901-287-6804
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:GROUND FL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103
Practice Address - Country:US
Practice Address - Phone:901-287-7337
Practice Address - Fax:901-287-6042
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD411302085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3820604Medicaid
KS100287100AMedicaid
TN3820604Medicaid
TN3820604Medicaid
KS051595Medicare ID - Type Unspecified