Provider Demographics
NPI:1467453142
Name:WOLDOW, ANDREW BENNETT (MD)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:BENNETT
Last Name:WOLDOW
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 1:8200 HENRY AVE
Mailing Address - Street 2:STE G-1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2984
Mailing Address - Country:US
Mailing Address - Phone:215-482-2336
Mailing Address - Fax:215-483-4389
Practice Address - Street 1:8200 HENRY AVE
Practice Address - Street 2:STE G-1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2984
Practice Address - Country:US
Practice Address - Phone:215-482-2336
Practice Address - Fax:215-483-4389
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026439E207R00000X, 207RC0000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001012801Medicaid
PA124134OtherBLUE SHIELD
PA026894Medicare ID - Type Unspecified
PA124134OtherBLUE SHIELD