Provider Demographics
NPI:1477535938
Name:ADAMCZAK, ANDREA L (PA)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:ADAMCZAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 ATHERHOLT ROAD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2113
Mailing Address - Country:US
Mailing Address - Phone:434-947-3993
Mailing Address - Fax:434-847-2941
Practice Address - Street 1:2321 ATHERHOLT ROAD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2113
Practice Address - Country:US
Practice Address - Phone:434-947-3993
Practice Address - Fax:434-847-2941
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477535938OtherMEDICARE RAILROAD
VAQ69983Medicare UPIN
VA1477535938OtherMEDICARE RAILROAD
VA1477535938Medicare PIN