Provider Demographics
NPI:1609162742
Name:LIM, ANDY (MD)
Entity Type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5717 VIRGINIA PINE CT
Mailing Address - Street 2:APARTMENT C
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1759
Mailing Address - Country:US
Mailing Address - Phone:913-461-1082
Mailing Address - Fax:
Practice Address - Street 1:1160 COMMERCE DR STE A
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8448
Practice Address - Country:US
Practice Address - Phone:575-622-5600
Practice Address - Fax:575-622-3720
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0116028922207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52837Medicaid