Provider Demographics
NPI:1477581569
Name:KWAK, ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:KWAK
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 1:919 CONESTOGA RD
Mailing Address - Street 2:BUILDING TWO, SUITE 305
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1352
Mailing Address - Country:US
Mailing Address - Phone:610-525-0606
Mailing Address - Fax:610-525-5912
Practice Address - Street 1:919 CONESTOGA RD
Practice Address - Street 2:BUILDING TWO, SUITE 305
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1352
Practice Address - Country:US
Practice Address - Phone:610-525-0606
Practice Address - Fax:610-525-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD074005L2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA057529Medicare ID - Type Unspecified
H59929Medicare UPIN