Provider Demographics
NPI:1437181542
Name:ANYADIEGWU, ANDREW E (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:E
Last Name:ANYADIEGWU
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 1:203 WALLS DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7022
Mailing Address - Country:US
Mailing Address - Phone:817-641-0808
Mailing Address - Fax:
Practice Address - Street 1:203 WALLS DR
Practice Address - Street 2:SUITE 208
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7022
Practice Address - Country:US
Practice Address - Phone:817-641-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 426941207RC0200X
PAMD426941207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101434984Medicaid
092893Medicare ID - Type Unspecified
PA101434984Medicaid