Provider Demographics
NPI:1467683714
Name:JOSEPH, ANDREA RENE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:RENE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 NIGHTSONG LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2045
Mailing Address - Country:US
Mailing Address - Phone:301-362-5993
Mailing Address - Fax:
Practice Address - Street 1:2 HAMILL RD STE 345
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1874
Practice Address - Country:US
Practice Address - Phone:410-433-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2160152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist