Provider Demographics
NPI:1558350082
Name:ANDREWS, DIANNA L I (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:L
Last Name:ANDREWS
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46068-9412
Mailing Address - Country:US
Mailing Address - Phone:765-963-6006
Mailing Address - Fax:765-963-6060
Practice Address - Street 1:104 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46068-9412
Practice Address - Country:US
Practice Address - Phone:765-963-6006
Practice Address - Fax:765-963-6060
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059022A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200478080AMedicaid
IN200478080Medicaid
IN222920Medicare ID - Type Unspecified
IN200478080AMedicaid
IN200478080Medicaid
IN222920AMedicare ID - Type Unspecified