Provider Demographics
NPI:1376700773
Name:NEVIASER, ANDREW SHEDDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SHEDDEN
Last Name:NEVIASER
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 715868
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19171-5868
Mailing Address - Country:US
Mailing Address - Phone:804-915-4067
Mailing Address - Fax:804-968-1803
Practice Address - Street 1:1760 OLD MEADOW ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4306
Practice Address - Country:US
Practice Address - Phone:703-810-5217
Practice Address - Fax:614-293-2053
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD039789207XS0114X
OH35131849207XS0114X
VA0101271638207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0229682Medicaid