Provider Demographics
NPI:1598977670
Name:ANDREW J MAXWELL, M.D. INC
Entity Type:Organization
Organization Name:ANDREW J MAXWELL, M.D. INC
Other - Org Name:HEART OF THE VALLEY PEDIATRIC CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-416-0100
Mailing Address - Street 1:5933 CORONADO LN
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8597
Mailing Address - Country:US
Mailing Address - Phone:925-416-0100
Mailing Address - Fax:925-397-2193
Practice Address - Street 1:5933 CORONADO LN
Practice Address - Street 2:SUITE 104
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8597
Practice Address - Country:US
Practice Address - Phone:925-416-0100
Practice Address - Fax:925-397-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA486672080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH66299Medicare UPIN