Provider Demographics
NPI:1427009588
Name:GUEVARRA, ANDRES TIANGCO (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:TIANGCO
Last Name:GUEVARRA
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 1:212 W ROUTE 38 STE 400
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3259
Mailing Address - Country:US
Mailing Address - Phone:856-235-0264
Mailing Address - Fax:856-235-4635
Practice Address - Street 1:212 W ROUTE 38
Practice Address - Street 2:SUITE 400
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3238
Practice Address - Country:US
Practice Address - Phone:856-235-0264
Practice Address - Fax:856-235-4635
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04812200208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2436302Medicaid
NJD19729Medicare UPIN