Provider Demographics
NPI:1477647667
Name:SCOMA, ANDREW V (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:V
Last Name:SCOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDREW
Other - Middle Name:J
Other - Last Name:SCOMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1925 MIZELL AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:407-628-0448
Mailing Address - Fax:407-628-9867
Practice Address - Street 1:1925 MIZELL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-628-0448
Practice Address - Fax:407-628-9867
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22529207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269823400Medicaid
FL269823400Medicaid
FL68051Medicare PIN