Provider Demographics
NPI:1508869793
Name:DAVIDOFF, ANDREW M (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:DAVIDOFF
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:262 DANNY THOMAS PLACE, MS 0515
Mailing Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PLACE, MS 0515
Practice Address - Street 2:ST. JUDE CHILDREN'S RESEARCH HOSPITAL
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-04-05
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Provider Licenses
StateLicense IDTaxonomies
TN292602086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100016910AMedicaid
OH2033963Medicaid
NC7612100Medicaid
IL036093610-3Medicaid
NJ6514201Medicaid
MS00118708Medicaid
MT0149566Medicaid
ME422400000Medicaid
AR133131001Medicaid
KS200377030AMedicaid
LA1549606Medicaid
MO205026701Medicaid
AL009914190Medicaid
TN3818503Medicaid
IN200110730AMedicaid
KY64927858Medicaid
IA0527846Medicaid
MI104802025Medicaid
TN3818503Medicaid
NC7612100Medicaid