Provider Demographics
NPI:1487630224
Name:GOSHEN, ANDREA MARIE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:MARIE
Last Name:GOSHEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:SCHANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:PO BOX 20907
Mailing Address - Street 2:
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-0907
Mailing Address - Country:US
Mailing Address - Phone:610-923-9663
Mailing Address - Fax:610-923-9661
Practice Address - Street 1:3735 NAZARETH RD
Practice Address - Street 2:STE 201
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8338
Practice Address - Country:US
Practice Address - Phone:610-923-9663
Practice Address - Fax:610-923-9661
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATMA051526363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ62523Medicare UPIN