Provider Demographics
NPI:1467450445
Name:ANDREOZZI, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ANDREOZZI
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 1:845 NORMAN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7445
Mailing Address - Country:US
Mailing Address - Phone:717-273-8091
Mailing Address - Fax:717-273-9081
Practice Address - Street 1:845 NORMAN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7445
Practice Address - Country:US
Practice Address - Phone:717-273-8091
Practice Address - Fax:717-273-9081
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD123456E174400000X
PAMD014933E207ZD0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1520325OtherGATEWAY INS PROVIDER #
PA01694001OtherCAP BC IND PROVIDER NUMBE
PA0006094390001Medicaid
PA178115HE5OtherPTAN
PA178115OtherBS IND PROVIDER NUMBER
PA178115HE5OtherPTAN