Provider Demographics
NPI:1629089784
Name:DELWADIA, ANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:
Last Name:DELWADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3021 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-5860
Mailing Address - Country:US
Mailing Address - Phone:423-502-8886
Mailing Address - Fax:
Practice Address - Street 1:444 CLINCHFIELD STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3606
Practice Address - Country:US
Practice Address - Phone:423-230-2500
Practice Address - Fax:423-230-7502
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14815207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3006294Medicaid
TNP00194762OtherRAIL ROAD MEDICARE
VA010118069Medicaid
TNP00194762OtherRAIL ROAD MEDICARE
TN3006294Medicaid